St. Anthony parish registration
today’s Date: Click here to enter text. (PRFOrm12-2011)
Family Information
Last Name:Click here to enter text.
Home Phone:Click here to enter text.	Cell Phone:Click here to enter text.
Current Address:Click here to enter text.
City:Click here to enter text.	State:Click here to enter text.	ZIP Code:Click here to enter text.
E-mail:Click here to enter text.	[Env. # Assigned by Office]:
Head of Household Information
Name:Click here to enter text.	Gender: ☐ Male ☐ Female	DOB (mm/dd/yyyy):Click here to enter text.
Work Phone:Click here to enter text.	Cell Phone:Click here to enter text.	E-mail:Click here to enter text.
Occupation:Click here to enter text.	Employer:Click here to enter text.	Education Level:Click here to enter text.
Marital Status: ☐Single ☐Married ☐ Separated ☐Divorced ☐Annulled	Religion:Click here to enter text.
Baptized ?: ☐Yes/ ☐No Catholic Baptism? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
1st Communion?: ☐Yes/ ☐No Where:Click here to enter text.	St. Anthony Alum? ☐Yes ☐No Yr:Click here to enter text.
Confirmation?: ☐Yes/ ☐No Where:Click here to enter text.
Marriage?: ☐Yes/ ☐No Valid Catholic Marriage? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
Spouse information
Name:Click here to enter text.	Gender: ☐Male ☐Female	DOB (mm/dd/yyyy):Click here to enter text.
Work Phone:Click here to enter text.	Cell Phone:Click here to enter text.	E-mail:Click here to enter text.
Occupation:Click here to enter text.	Employer:Click here to enter text.	Education Level:Click here to enter text.
Marital Status: ☐Single ☐Married ☐Separated ☐Divorced ☐Annulled	Religion:Click here to enter text.
Baptized ?: ☐Yes/ ☐No Catholic Baptism? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
1st Communion?: ☐Yes/ ☐No Where:Click here to enter text.	St. Anthony Alum? ☐Yes ☐No Yr:Click here to enter text.
Confirmation?: ☐Yes/ ☐No Where:Click here to enter text.
Marriage?: ☐Yes/ ☐No Valid Catholic Marriage? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
Dependent Child information
First Name:Click here to enter text.	Last Name:Click here to enter text.	Gender: ☐Male ☐Female
DOB (mm/dd/yyyy):Click here to enter text.	Birthplace:Click here to enter text.	H.S. Grad Year:Click here to enter text.
Baptized ?: ☐Yes/ ☐No Catholic Baptism? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
1st Communion?: ☐Yes/ ☐No Where:Click here to enter text.	St. Anthony Alum? ☐Yes ☐No Yr:Click here to enter text.
Confirmation?: ☐Yes/ ☐No Where:Click here to enter text.
Dependent child Information
First Name:Click here to enter text.	Last Name:Click here to enter text.	Gender: ☐Male ☐Female
DOB (mm/dd/yyyy):Click here to enter text.	Birthplace:Click here to enter text.	H.S. Grad Year:Click here to enter text.
Baptized ?: ☐Yes/ ☐No Catholic Baptism? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
1st Communion?: ☐Yes/ ☐No Where:Click here to enter text.	St. Anthony Alum? ☐Yes ☐No Yr:Click here to enter text.
Confirmation?: ☐Yes/ ☐No Where:Click here to enter text.
Dependent child Information
First Name:Click here to enter text.	Last Name:Click here to enter text.	Gender: ☐Male ☐Female
DOB (mm/dd/yyyy):Click here to enter text.	Birthplace:Click here to enter text.	H.S. Grad Year:Click here to enter text.
Baptized ?: ☐Yes/ ☐No Catholic Baptism? ☐Yes/☐No Where:Click here to enter text. Date:Click here to enter text.
1st Communion?: ☐Yes/ ☐No Where:Click here to enter text.	St. Anthony Alum? ☐Yes ☐No Yr:Click here to enter text.
Confirmation?: ☐Yes/ ☐No Where:Click here to enter text.
Miscellaneous Information
Most Recent Parish:Click here to enter text.	City/State:Click here to enter text.
St. Anthony Parish 830 Bowen St. Dayton, OH 45410 937.253.9132 jslider@stanthonydayton.org

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