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Submission Type REQUIRED NEW REGISTRATION ADD ANOTHER FAMILY MEMBER UPDATE REGISTRATION PLEASE REMOVE ME FROM THE PARISH REGISTRY Please fill out this field.

Parish REQUIRED Please fill out this field.

Family Information

Were you previously registered in another parish in the Diocese of Richmond? Yes No

If so, where? Please enter valid data.

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

Address 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.

Family Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Type of Phone REQUIRED Cell Work Home Please fill out this field.

Email REQUIRED Please fill out this field. Please enter an email address.

Do we have permission to publish your contact info within the parish? REQUIRED Yes No Please fill out this field.

Title Mr Mrs Ms Dr

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

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

If wife, maiden name Please enter valid data.

Marital Status REQUIRED Single Married Divorced Widowed Please fill out this field.

Position in Family REQUIRED Please fill out this field.

If Other, specify here. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

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

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

Ethnicity Please enter valid data.

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

School (if applicable) REQUIRED Please fill out this field. Please enter valid data.

UVA Affiliation REQUIRED Please fill out this field.

Phone Number Please enter a phone number.

Type of Phone Home Cell Work

Email Please enter an email address.

Sacraments Baptism Communion Confirmation Marriage

Information for Spouse (if applicable)

Title Mr Mrs Ms Dr

First Name Please enter valid data.

Last Name Please enter valid data.

If wife, maiden name Please enter valid data.

Position in Family

If Other, specify here. Please enter valid data.

Date of Birth Please enter a date.

Marital Status Single Married Divorced Widowed

Religion Please enter valid data.

Language Please enter valid data.

Ethnicity Please enter valid data.

Occupation Please enter valid data.

School (if applicable) Please enter valid data.

UVA Affiliation

Phone Number Please enter a phone number.

Type of Phone Home Cell Work

Email Please enter an email address.

Sacraments Baptism Communion Confirmation Marriage

I prefer to support the parish REQUIRED Please fill out this field.

Notes (anything we may have missed)

Registration/Update Form

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Family Information

Information for Spouse (if applicable)

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