Christian Initiation of Adults and Older Children

Information for Self or Child? REQUIRED For myself For my child Please fill out this field.

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

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

Birth Date REQUIRED Please fill out this field. Please enter valid data.

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Contact Information

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.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Home Phone Please enter valid data.

Email REQUIRED Please fill out this field. Please enter valid data.

Occupation Please enter valid data.

Father's Name

Why do we ask this? This will eventually be needed when recording your reception of any of the sacraments of initiation. It's part of ancient practice to uniquely identify individuals. You can provide this later if you desire.

Please enter valid data.

Mother's Name

Why do we ask this? This will eventually be needed when recording your reception of any of the sacraments of initiation. It's part of ancient practice to uniquely identify individuals. You can provide this later if you desire.

Please enter valid data.

SACRAMENTS

You will later need to provide a copy of your Baptismal certificate, Marriage certficate and/or annulment documents depending on your status.

Baptism

Are you baptized? REQUIRED Yes No Please fill out this field.
If yes,
Date of Baptism
Take a guess for now
Please enter valid data.
Church of Baptism
Name of the church in which you were baptized
Please enter valid data.
Location of Baptism Please enter valid data.
Denomination of Baptism Please enter valid data.

Eucharist

For baptized Catholics,
Have you received your First Communion? Yes No
If yes,
Date of First Communion
Take a guess for now
Please enter valid data.
Church of First Communion Please enter valid data.

Matrimony

Please explain why you are desiring full initiation into the Catholic Church at this time.

Comments REQUIRED Please fill out this field.

Please note: A signature of the parent or guardian is required for older childen or minors and can be added to this form at a later time.