How To Register

Last Name

First Name

Date of Birth

Gender

Male
Female

Marital Status

Single
Married
Separated
Divorced

If married, married by

Priest
Deacon

Please indicate which of the following Sacraments you have received:

Baptism
Catholic
RCIA
Reconciliation
First Eucharist/Communion
Confirmation

Address

Street

(Apt. Suite, Lot #)

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Do you wish to receive the Georgia Bulletin Newspaper?

yes
no

Do you wish to receive mail?

yes
no

May we print your name and contact information in our parish directory?

yes
no

Primary Language

Occupation

Family Members Residing With You

Family Member #1

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #2

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #3

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #4

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #5

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #6

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

Family Member #7

First Name

Last Name

Gender

Date of Birth

Relationship to you

Occupation

Employer/School

Special Needs

Grade

Baptized?

yes
no

First Communion?

yes
no

Confirmation?

yes
no

MINISTRY OPPORTUNITIES AT IMMACULATE HEART OF MARY

Please check all ministries that might be of interest to you

ADMINISTRATIVE

Parish Office Volunteer
Assist with bulk mailings
Help plan parish-wide events

ADVISORY COMMITTEES

Worship Committee
Stewardship Committee

LITURGY AND PRAYER

COMMUNITY: OUTREACH

AIDS Ministry
Crossroads Community Ministry (Soup Kitchen)
Nicholas House
St. Vincent de Paul
Mustard Seed Communities

COMMUNITY: SOCIAL CONCERNS

Pro-Life Committee
Social Justice Committee

COMMUNITY: FELLOWSHIP

TALENT BANK

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