St. John the Evangelist Church Registration 552 Cabot St Beverly, MA 01915 978-922-5542 stjohnrc@parishmail.com
Registration Date: __ / __ / __ Contrib. Env.? Y / N for office use only Env#_______
Family Information:
Last Name: ________________________ Home Phone: ______________________
First Name(s) ______________________ Family Email: ______________________
Address: ______________________ Permission to publish phone, address, email in Parish Directory
______________________ Publish Phone? Y / N Publish Address? Y / N Publish Email? Y / N
City: ___________State: ____ Zip: _____-____ School: _____________
Marital Status: ______
Married by Priest/Deacon? Y / N
Anniversary Date: __ / __ / __
Wedding Church/City: __________________
Husband/Head: ___________________________ Wife(Maiden name): ___________________________
Catholic? Y / N Active / Inactive / Other:_______ Catholic? Y / N Active / Inactive / Other_______
DOB: ___/___/___ ___/___/___
Sacramental Info: Baptized? Y /N RCIA? Y / N Baptized? Y / N RCIA? Y / N
Reconcil? Y / N First Euch.? Y / N Reconcil? Y / N First Eucharist? Y / N
Confirmed? Y / N
Occupation: __________________________ _________________________________
Work Phone: __________________________ _________________________________
Email: __________________________ _________________________________
Child Name: DOB Sex Grade
____________________________ ___ / ___ / ___ M / F ______ Special Needs: _________________________
Baptism Y / N Catholic? Y / N First Euch. Y / N Reconcil. Y / N Confirmation Y / N Add Sacrament Date if known. ___ / ___ / ___ ___ / ___ / ___ ___ / ___ / ___ ___ / ___ / ___
Child Name: ____________________________ DOB: ___ / ___ / ___ M / F Grade: ___ Special Needs:____________________
Child Name: ____________________________ DOB:___ / ___ / ___ M / F Grade: ____ Special Needs:____________________
Child Name: ____________________________ DOB: ___ / ___ / ___ M / F Grade:___ Special Needs: ____________________
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