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New Parishioner Registration Form

- Forms
  - Parish Forms
    
    Children's Faith Formation Registration
    Youth Faith Formation Registration
    Youth Group Registration
    Youth Group Volunteer
    ACH Form
    New Parishioner Registration Form
    
    Photo Release Form - Minor
    Photo Release Forms - Adults
    Request Mass Intention
    Sacramental Certificate Request
    Sponsor Form (Baptism or Confirmation)
    Update or Change Parishioner Information
  - Young Adult Ministry Inquiry

The maximum number of form submissions has been reached. This form is currently not available.
- Welcome to St. Catherine's! We're so glad you've decided to join our parish!
  
  Please complete the first part of this registration form (Primary Member - Section One) for yourself. If there are no other family members living in your household, please skip the Additional Family Members section and click the SUBMIT button at the bottom of the page.
  
  To register additional family members, please go to the Additional Family Members section, indicate the total number of additional family members (not including yourself) living in your household in the field where indicated, and then complete the information requested for each additional family member.
  
  Thank you!
- PRIMARY MEMBER
- Family Name (Full name of husband and wife if married) Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- Your Street Address: REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Your Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email Address: REQUIRED Please fill out this field. Please enter valid data.
- First Member's Full Name (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (if applicable): Please enter valid data.
- Your Title: Please enter valid data.
- Relationship REQUIRED Please fill out this field.
- Your Gender: REQUIRED Male Female Please fill out this field.
- Your Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Your Place of Birth (City, State): Please enter valid data.
- Your Religion (if not Catholic): Please enter valid data.
- Your Employer (if unemployed, please type "None"): Please enter valid data.
- Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
- Sacramental Information
  
  Please complete the following section if you have been baptized (whether Catholic or other faith).
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Sacramental Information None Baptism Reconciliation First Communion Confirmation
  
  Baptism Information
  
  Church of Baptism: Please enter valid data.
  
  City / State of Baptism: Please enter valid data.
  
  Date of Baptism: Please enter a date.
- Your Marriage Information (if applicable)
  
  Church of Marriage: Please enter valid data.
  
  City / State of Marriage: Please enter valid data.
  
  Date of Marriage: Please enter a date.
- Your Former Parish (if applicable): Please enter valid data.
- How can we serve your family? Religious Education / Children's Faith Formation Classes House Blessing RCIA / Interested in Becoming Catholic Baptism Marriage Preparation Other
- I would prefer to contribute: using envelopes using Online Giving (stcatherinesiena.org/give) using online banking using automatic withdrawal (ACH)
- Why did you choose St. Catherine's?
- We automatically add your email to our Flocknote and "Engage Your Faith" email list with occasional parish news and short faith-based messages. Are you okay with being added to this email list? REQUIRED Please fill out this field.
- You may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your photo or video clips of you for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
- Permission to use your picture/video? REQUIRED YES, St. Catherine's may use photos/videos of me NO, St. Catherine's may NOT use photos/videos of me Please fill out this field.
- ADDITIONAL FAMILY MEMBERS
- Are there additional family members living in your household?
  If YES, please indicate the total number of ADDITIONAL family members (NOT INCLUDING YOURSELF) you would like to register in the field below and complete the requested information for each additional member of your household. Please hit the SUBMIT button at the bottom of the page when you are finished.
  
  If NO, please SKIP this section for additional family members, and scroll down to the SUBMIT button at the bottom of the page.
- Number of Additional Family Members Living in Your Household: REQUIRED
  Please indicate the total number of ADDITIONAL family members living in your household (NOT INCLUDING YOURSELF)
  Please fill out this field.
  
  Additional Family Member 1
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 2
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 3
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 4
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 5
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 6
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 7
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 8
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 9
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
  
  Additional Family Member 10
  
  Type: Adult Child Other
  
  Relationship REQUIRED Please fill out this field.
  
  First Name: Please enter valid data.
  
  Middle Name: Please enter valid data.
  
  Maiden Name (if applicable): Please enter valid data.
  
  Last Name: Please enter valid data.
  
  Gender: Male Female
  
  Birth Date: Please enter a date.
  
  Your Employer (if unemployed, please type "None"): Please enter valid data.
  
  Your Occupation / Business (if unemployed, please type "None"): Please enter valid data.
  
  Religion (if not Catholic): Please enter valid data.
  
  Sacramental Information
  
  Birth Date Please enter valid data.
  
  Father's Name Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Please indicate which Sacraments this family member has received: None Baptism (please complete additional Baptism information below) Reconciliation First Eucharist Confirmation
  
  Date of Baptism: Please enter a date.
  
  Church of Baptism: Please enter valid data.
  
  City/State of Baptism: Please enter valid data.
  
  Current Grade (children only):
  
  Does Your Child Attend one of our CSGK Catholic Schools (children only)? Yes (please specify name of Catholic School below) No (please indicate other school name below)
  
  School Name (children only): Please enter valid data.
  
  Place of Birth (City, State): Please enter valid data.
  
  Phone Number (if different from above): Maximum 20 characters Please enter a phone number.
  
  Your family member may be included in photographs and/or videos taken during St. Catherine of Siena Parish's Masses and activities.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your family member's photo/video to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Catherine of Siena Parish in Portage, Michigan, permission to edit, use, and reuse photos/videos for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Catherine of Siena Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Catherine of Siena Parish to use your family member's photo or video clips of your family member for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
  
  Permission to use your family member's picture/video? REQUIRED YES, St. Catherine's may use photos/videos of my family member NO, St. Catherine's may NOT use photos/videos of my family member Please fill out this field.
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