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New Parishioner

WELCOME!

We’re so glad you’re here! Are you interested in joining St. Mary Catholic Church? Print and fill out the new parishioner registration form OR complete the online registration below.

New Parishioner Registration Form

New Parishioner Registration

Name

This field is for validation purposes and should be left unchanged.

Person 1 (Head of Household)(Required)

First Middle Last Maiden (if applicable)

Sex

Male

Female

Date of Birth

Religion

Marital Status

Single

Married

Divorced

Widowed

Separated

Sacraments Received

Baptism

First Communion

Confirmation

Wedding Anniversary Date

Email(Required)

Phone(Required)

Person 2 (Spouse)

First Middle Last Maiden (if applicable)

Sex

Male

Female

Date of Birth

Religion

Marital Status

Single

Married

Divorced

Widowed

Separated

Sacraments Received

Baptism

First Communion

Confirmation

Email

Phone

Address

Family Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Children

Child 1

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Child 2

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Child 3

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Child 4

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Child 5

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Child 6

First Middle Last

Date of Birth

Grade in School

Baptized

Yes

No

First Communion

Yes

No

Confirmation

Yes

No

Additional information you'd like to provide:

Date

Social Media

Contact

726 218th Place Pella IA 50219 Phone: (641) 628-3078 pellastmary@diodav.org

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