ST - Clover Sites
ST. JOSEPH CATHOLIC CHURCH
108 St. Joseph Street / PO Box 220
Kannapolis, NC 28083
(704) 932-4607 / Fax # (704) 932-0566
PARISH REGISTRATION FORM
Name and City/State of Previous Parish _____________________________________________
Title: Mr. & Mrs. Mr. Mrs. Miss Ms. Dr. Dr. & Mrs.
Last Name: ___________________________ Wife’s Maiden Name _____________________
Address: _____________________________________________________________
City __________________________ State ______ Zip Code _________
Telephone #: _______________________ Unlisted Number: Y or N?
E-Mail Address: ____________________________________________________________
Head of Family – First Name - ___________________________
Occupation: _______________________ Business Phone: ____________________
Birth Date: ____________________ Religion:_____________________
Marital Status: ________________ Date of Marriage: _____________
Other Languages Spoken: _____________________________
Handicap: __________________________________________
Sacraments received: Baptism ___ First Communion ___ Confirmation ___
Spouse – First Name- __________________________________
Occupation: ______________________ Business Phone:_____________________
Birth Date: ______________________ Religion: __________________________
Marital Status: ___________________ Date of Marriage: ___________________
Other Languages Spoken: _____________________________________________
Handicap:__________________________________________________________
Sacraments received: Baptism ___ First Communion ___ Confirmation ___
Please fill out the following information for children living in your household
NAME SEX DOB SACRAMENTS RECEIVED
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
_______________________ ___ ________ ________________________________
Is there a shut-in living in the home? ________________
COMMENTS/SUGGESTIONS:
After completion, please return this form to the Parish Office at the address on the other
side, or you may drop it in the collection plate on Sunday.
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