St. Anthony Parish Registration Form

Member of Household Form -- (Please submit a separate form for each member)

* Required Fields

Head of Household * First & Last Name:
MEMBER OF HOUSEHOLD Fill in the form below for a member of the household.
Title:	Mr.   Mrs.   Ms.   Dr.   Miss   Other:
* First Name:
* Last Name:
Name by which you would like to be addressed:
Current Marital Status:	Married   Single   Widowed   Separated Divorced Annulled
* Relationship to Head of Household:	Self   Spouse   Child   Other:
Birth Date:
Gender:	Male   Female
Ethnicity:	African-American  Asian   Caucasian   Hispanic   Other:
Language(s) Spoken: (other than English)	Spanish   Italian  French  Polish  Other:
Occupation:
Grade/Degree Completed:
Special Needs:	None   Blind  Deaf   Mentally Handicapped Physically Handicapped   Shut-in   Other
	If Shut-in, would you like Holy Communion or any other Sacrament brought to your home? Yes   No
Attends Church:	Daily   Weekly  Occasionally   Seldom   Never
Religion:	Catholic   Protestant   Muslim   Jewish Other:
Please check Sacrament(s) that you have received:	Baptism   Confirmation   Holy Communion Reconciliation Marriage
	If married, is the marriage recognized by the Catholic Church? Yes   No   Date:
	Do you have any special concerns that you would like to speak to a Pastor about? Yes   No
Comments:

Member's Talents - Check all that apply:
Art Auto Mech Babysitting Beautician Bookkeeping Builder Business Carpentry Clerical Communications Computers Construction Crafts Culinary Arts	D.J. Dancing Data Entry Day Care Dialysis Driver Education Electrician Electronics EMT Engineer Finance Florist/Plant Care Gardening	Graphic Design Hairdresser Health Care Housekeeping Interior Design IT Support Knit/sew/crochet Landscaping Law Maintenance Marketing Mason Musician Nursing	Painting Photography Plumbing Printer Public Relations Public Speaking Remodeling Sports Stained Glass Travel Agent Typing Web Design Other:

Committee Interests Please indicate if you are ACTIVE in any of the following committees or if you are INTERESTED in joining. A committee member will contact you to discuss your availability.

Liturgy and Spirituality Active Interested  Adult Altar Server Active Interested  Altar Server Active Interested  Altar Society (maintain altar linens) Active Interested  Babysitting During 9:30 Mass Active Interested  Children's Liturgy of the Word Active Interested  Extraordinary Ministers of Communion Active Interested  Greeters Active Interested  Liturgical Connections Committee Active Interested  Music Program Active Interested  Prayer Line and Prayer Basket Active Interested  Readers Active Interested  Sacristy and Mass Preparations Active Interested  Seasonal Sanctuary Decoration Active Interested  Ushers/Collectors Active Interested  Wedding Preparation (Rehearsals) Faith Formation Active Interested  Adult Education and Formation Active Interested  Adult Sacramental Preparation Active Interested  Baptismal Preparation Active Interested  Family Chalice for Vocations Program Active Interested  First Communion/Confirmation Preparation Active Interested  Marriage Preparation Active Interested  Religious Education Committee Active Interested  Small Christian Community Active Interested  Vacation Bible Camp Active Interested  Youth in Action Active Interested  Youth Religious Education (Catechists) Social / Pastoral Active Interested  Bereavement Active Interested  Convalescent Homes Active Interested  Elderly and Shut-ins

Social / Pastoral (cont.) Active Interested  Food Pantry and Holiday Collections Active Interested  Giving Tree Active Interested  Hospital Ministry Active Interested  Lazarus/Bereavement Active Interested  Pro-Life Active Interested  Social Justice Committee Active Interested  St. Vincent DePaul Kitchen/Shelter Parish Life Active Interested  Baking Active Interested  Bingo Active Interested  Feast Day Active Interested  Hospitality Committee (Coffee Hour) Active Interested  Knights of Columbus Active Interested  Ladies Guild Active Interested  Mothers Group Active Interested  Parish Picnic Active Interested  Photography Active Interested  Special Events as Needed Active Interested  Web Site / Communications Active Interested  Wheels of Faith (Drivers) Stewardship Active Interested  Finance Council Active Interested  Pastoral Council Active Interested  Stewardship Committee Parish Support Active Interested  Collection Counters Active Interested  Light Church Housekeeping Active Interested  Office Volunteer Active Interested  Telephone Volunteer Check here if you have questions and would like to be contacted.