Registration Form

Name: (First, Middle, and Last) REQUIRED Please fill out this field. Please enter valid data.

Maiden Name (if applicable) Please enter valid data.

Address REQUIRED Please fill out this field.

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.

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

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

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

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

Name of Father (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.

Name of Mother (First, Middle, and Maiden Name) REQUIRED Please fill out this field. Please enter valid data.

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

Have you ever been baptized? REQUIRED Yes No I am not sure Please fill out this field.

If you answered yes..what religious affiliation? Please also provide the name of the Church and its location

If you were baptized as a Catholic, check those sacraments you have already received: Confirmation Holy Communion Reconciliation

Current Marital Status (This question will be discussed in more detail during your interview) REQUIRED Single Currently Engaged Married Divorced (Not remarried) Divorced (Remarried Outside the Church) Divorced (Married Validly in the Church) Please fill out this field.

If engaged is this your first marriage? Yes No

If "no" please indicate the number of times you were married before

If more than one previous spouse, please indicate in detail how each marriage ended (death or divorce)

If divorced was the marriage ever annulled in the Catholic Church Yes No

Name of Finance (First, Middle, Last) Please enter valid data.

Was your fiance ever married before Yes No

If "yes" please indicate the number of previous marriages

If yes, please indicate the nature of how the marriage ended Death of Former Spouse Divorce

If more than one previous spouse, please indicate in detail how each marriage ended (death or divorce)

If divorced was the marriage ever annulled in the Catholic Church? Yes No

Name of Spouse (First, Middle, and Maiden) Please enter valid data.

Was your spouse ever married before? Yes No

If yes, please indicate the number of times

If yes, please indicate the nature of how the marriage ended Death of Former Spouse Divorce

If more than one previous spouse, please indicate in detail how each marriage ended (death or divorce)

If divorced was the marriage ever annulled in the Catholic Church? Yes No

Please describe your religious background REQUIRED Please fill out this field.

What inspired you to consider the Catholic Church? REQUIRED Please fill out this field.

Name of Sponsor (First, Middle, Last,) Please refer to the qualifications of a sponsor. Please enter valid data.

Saint Patrick Catholic Church
219 S. Beaver Street York Pa

(717) 848-2007

Registration Form

R.C.I.A Registration form notes...

r.c.i.a. Registration Form