Parish Registration General InformationToday's Date:* Date Format: MM slash DD slash YYYY Family Last Name:*Have you been a member of a parish previously?* Yes No If yes, where?Contact InformationHow would you like your mail to be addressed? Mr. & Mrs. Mr. Mrs. Ms. Miss Other (please specify) Male Head of Household Name First Last Female Head of Household Name First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have children living in your household?* Yes No Child One: Name, Age and GradeChild Two: Name, Age and GradeChild Three: Name, Age and GradeChild Four: Name, Age and GradePlease add any additional children with name, age and grade.Preferred Email* Enter Email Confirm Email Please include the email that you would like Saint George to use for sending notifications and information to your family.Primary Home Phone*Male Cell PhoneFemale Cell PhoneOther Cell PhoneAdditional InformationWould you like to receive weekly church contribution envelopes?* Yes No Would you like to receive information about Automatic Offertory Withdrawal?* Yes No
