Family Registration

Family Name REQUIRED Please fill out this field. Please enter valid data.

First Name - Head of Household REQUIRED Please fill out this field. Please enter valid data.

First Name - Spouse Please enter valid data.

Street Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Residence Phone Number Please enter a phone number.

Mobil Phone Number Please enter a phone number.

Email Please enter an email address.

If your mailing address is different from your street address, please also fill out your mailing contact information:

Mailing Address or PO Box Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Language Preferred English Spanish

Church Attending St. Francis, Burney Our Lady of the Valley, Fall River Mills St. Stephen's, Bieber

Children in the Home: REQUIRED Please fill out this field.
Child 1
- First Name Please enter valid data.
- Year of Birth Maximum 4 characters Please enter valid data.
Child 2
- First Name Please enter valid data.
- Year of Birth Maximum 4 characters Please enter valid data.
Child 3
- First Name Please enter valid data.
- Year of Birth Maximum 4 characters Please enter valid data.
Child 4
- First Name Please enter valid data.
- Year of Birth Maximum 4 characters Please enter valid data.

Other Information You Think We Should Know

Maximum 250 characters

You agree that we can use this information to contact you by phone, regular mail, email or text.

I Agree Please select this field.

St. Francis of Assisi Parish