RCIA Registration

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

Middle Name Please enter valid data.

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

Maiden Name (if applicable) Please enter valid data.

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

Place of Birth: Locality (town, city, county) REQUIRED Please fill out this field. Please enter valid data.

Place of Birth: Region (state, province, territory) REQUIRED Please fill out this field. Please enter valid data.

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

Current 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.

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

Is this a cell phone or a landline? REQUIRED Cell phone Landline Please fill out this field.

Is this a personal phone number or work number? REQUIRED Personal Work Please fill out this field.

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

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

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

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

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

Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.

Religious History

What, if any, is your present religious affiliation? REQUIRED Please fill out this field. Please enter valid data.

Have you been baptized? REQUIRED Yes, I was baptized in the Catholic faith. Yes, I was baptized in another faith. No, I have not been baptized, or I am not sure. Please fill out this field.

If you have been baptized, please answer the following questions about your baptism. If you have not been baptized, you may skip these questions.

On what date were you baptized? Please enter valid data.

What is the name of the church where you were baptized? Please enter valid data.

What is the address of the church where you were baptized? Please enter valid data.

Marital Status REQUIRED I am single. (See follow up questions below.) I am engaged. I am married. (See follow up questions below.) Please fill out this field.

If you are single: I have never been married. I am divorced. I am a widow(er).

If you are married: This is my first marriage. I am divorced and remarried.

Answer the following only if you are married:

Spouse's name Please enter valid data.
Has your spouse been married prior to your current marriage? Yes No
Has your spouse been baptized? Yes No Not sure
If your spouse has been baptized, in what denomination was he or she baptized? Please enter valid data.
What is the date of your marriage? Please enter valid data.
Where were you married? (Church name, if applicable, and city/state) Please enter valid data.
Who was the officiating authority at your wedding?

Please list the names and ages of any children under 18 living in your household.

Were your children baptized? Yes No

If your children were baptized, in what denomination were they baptized? Please enter valid data.

What or who has led you to want to know more about the Catholic faith? What experience have you had with the Catholic Church so far? REQUIRED Please fill out this field.

Please describe your religious background. How involved have you been in your faith tradition? REQUIRED Please fill out this field.

What are some questions or concerns you have about the Catholic Church? REQUIRED Please fill out this field.

At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church? (please choose one) REQUIRED I need much more information about the Catholic Church before I would consider joining. I am considering joining, but I am still unsure about it. I am fairly sure that I would like to join, but I still need some time to study and pray about it. I am fairly sure that I want to join the Catholic Church. Please fill out this field.