Saint Richard Parish Family Registration 3841 Dickey Rd, Gibsonia, PA, 15044 724-444-1971 Office Use Only Reg. Date____________ Entered by___________ (Initials) Envelope #___________ GENERAL INFORMATION FAMILY NAME: _____________________________ MAILING NAME (i.e. Mr. &Mrs. John Doe): ____________________________________________ ADDRESS: ____________________________________________ HOME PHONE: ______________________ ____________________________________________ EMERG. PHONE: ______________________ CITY STATE ZIP CODE EMAIL ADDRESS: ____________________________________________ MARRIAGE STATUS: ______________________ If married, please complete the following: Date of Marriage: _______________ Is your marriage recognized by the Catholic Church: Yes □ No □ Name of Church: ______________________ City and State: _________________________________________ DO YOU WISH TO RECEIVE A FREE SUBSCRIPTION TO THE PITTSBURGH CATHOLIC NEWSPAPER? Yes □ No □ INDIVIDUAL INFORMATION HEAD OF HOUSEHOLD FIRST NAME: _____________________ M.I. ___ PREFERRED NAME: _____________________ LAST NAME: ________________ (If different from FAMILY NAME) DATE OF BIRTH: _______________ GENDER: M / F RELIGION: ____________________ EMPLOYER: __________________________ MAIDEN NAME: _____________________ OCCUPATION: __________________________ SACRAMENTS: WORK PHONE: ___________________ BAPTIZED: Y / N CHURCH: _____________________ CELL PHONE: ___________________ DATE OF BAPTISM: CITY AND STATE: ______________________ ____________ EUCHARIST: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CONFIRMED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ SPOUSE FIRST NAME: _____________________ M.I. ___ PREFERRED NAME: _____________________ LAST NAME: ________________ (If different from FAMILY NAME) DATE OF BIRTH: _______________ GENDER: M / F RELIGION: ____________________ EMPLOYER: __________________________ OCCUPATION: __________________________ SACRAMENTS: MAIDEN NAME: _____________________ WORK PHONE: ___________________ BAPTIZED: Y / N CHURCH: _____________________ CELL PHONE: ___________________ DATE OF BAPTISM: CITY AND STATE: ______________________ ____________ EUCHARIST: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CONFIRMED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CHILDREN/OTHERS LIVING IN HOME (Please do not list children over 21 yrs. unless they are still dependent children—Children over 21 yrs. should register separately even if living in home) 1. FAMILY RELATIONSHIP: ______________________ FIRST NAME: _________________ M.I. ___ PREFERRED NAME: ___________________ LAST NAME: ______________________ (If different from FAMILY NAME) DATE OF BIRTH: _______________ GENDER: M / F RELIGION: ____________________ SCHOOL GRADE: _______ SCHOOL ATTENDING: ____________________ RELIGIOUS EDUCATION GRADE: _______ (If completed during the summer, please list which grade child is entering) SACRAMENTS: BAPTIZED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ EUCHARIST: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CONFIRMED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ DATE OF BAPTISM: ____________ 2. FAMILY RELATIONSHIP: ______________________ FIRST NAME: _________________ M.I. ___ PREFERRED NAME: ___________________ LAST NAME: ______________________ (If different from FAMILY NAME) DATE OF BIRTH: _______________ GENDER: M / F RELIGION: ____________________ SCHOOL GRADE: _______ SCHOOL ATTENDING: ____________________ RELIGIOUS EDUCATION GRADE: _______ (If completed during the summer, please list which grade child is entering) SACRAMENTS: BAPTIZED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ EUCHARIST: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CONFIRMED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ DATE OF BAPTISM: ____________ 3. FAMILY RELATIONSHIP: ______________________ FIRST NAME: _________________ M.I. ___ PREFERRED NAME: ___________________ LAST NAME: ______________________ (If different from FAMILY NAME) DATE OF BIRTH: _______________ GENDER: M / F RELIGION: ____________________ SCHOOL GRADE: _______ SCHOOL ATTENDING: ____________________ RELIGIOUS EDUCATION GRADE: _______ (If completed during the summer, please list which grade child is entering) SACRAMENTS: BAPTIZED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ EUCHARIST: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ CONFIRMED: Y / N CHURCH: _____________________ CITY AND STATE: ______________________ *NOTE: IF YOU NEED TO ADD ADDITIONAL CHILDREN, PLEASE USE A SECOND FORM. DATE OF BAPTISM: ____________ SAINT RICHARD PARISH TIME AND TALENT COMMITMENT FORM The Lord has blessed us all with special gifts. We are challenged to share these gifts with our parish and our community. Please consider sharing 5% of a 40 hour week (2 hours) with our parish in service to the Lord. Check the box of all Ministries and organizations in which you wish to serve. All family members should fill out the survey. Please indicate individual family members’ interest as follows: Head of Household, #1; Spouse, #2; Children in order of registration, #3, #4, etc. Spirituality and Worship [ ] Ushers/Greeters [ ] Lectors [ ] Eucharistic Ministers [ ] Home Eucharistic Ministers [ ] Adult Choir [ ] Contemporary Choir [ ] Musician [ ] Cantor [ ] Handbell Choir [ ] Children’s Choir [ ] Altar Servers or Sacristan [ ] Children’s Liturgy of the Word [ ] Preparation of Worship Space for Seasons [ ] Spirituality & Worship Committee [ [ [ [ [ [ Social Concerns ] Comfort Blankets ] Divorce Support ] Emergency Relief Committee ] Food Bank ] Funeral Luncheons ] Good Neighbor Program [ ] Meals [ ] Caregiver Relief [ ] Handy Helpers [ ] Guatemala Mission [ ] Ladies of Charity [ ] Parish Nurses [ ] Respect Life Committee [ ] St. Vincent de Paul [ ] Stephen Ministry [ ] Welcome Committee Parish Groups [ ] Cursillo [ ] Forever Young (Senior Group) [ ] Ladies Group [ ] Men’s Group [ ] Parents of Little Ones (P.O.L.O.) [ ] Prayer Group [ ] Centering Prayer [ ] Marriage Encounter Faith Formation [ ] Religious Education Teacher/Aide [ ] Grades K-8 [ ] Edge (grades 6-8) [ ] LifeTeen (grades 9-12) [ ] Adult Formation/Bible Study [ ] R.C.I.A. [ ] Sponsor [ ] Catechist [ ] Hospitality Coordinator Administration [ ] Parish Mailings Assistance [ ] Office Assistance [ ] Parish Maintenance/Temporalities [ ] Dust Busters [ ] Grass Busters [ ] Landscape/Plants [ ] Altar Linens/Cloths [ ] Sanctuary Cleaners [ ] Stewardship/Fund Raising Saint Richard Church 3841 Dickey Road Gibsonia, PA 15044 _____________________________ _______________________ _______________________