New Parishioner Form

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

Street Address REQUIRED Please fill out this field. Please enter valid data.

* Please note apartment number on your address, if it applies.

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.

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

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

Language Spoken at Home REQUIRED Please fill out this field. Please enter valid data.

Head of Household: REQUIRED Please fill out this field.

Would you like us to send you Parish Envelopes?: REQUIRED Please fill out this field.

Below, please select the number of people living in your household, then complete the set of questions for each. When completed, press Submit. Thank you.

Persons in Household REQUIRED
Please complete information for each member of your household
Please fill out this field.
Person 1
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 2
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 3
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 4
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 5
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 6
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 7
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 8
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 9
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School
Person 10
- Name (Include Last Name if different) REQUIRED Please fill out this field. Please enter valid data.
- Type REQUIRED Please fill out this field.
- If you selected "Other" please describe:
  Grandparent, Aunt, Uncle ... ?
  Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Country of Birth
  If other than USA
  Please enter valid data.
- Religion
  If other than Roman Catholic
  Please enter valid data.
- Sacraments Received
  check all that apply
  Baptism First Communion First Confession Confirmation Sacramental Marriage
- If Child, Grade in School

Church of Immaculate Heart of Mary

Scarsdale, NY

New Parishioner Form

New IHM Parishioner Registration Form