RCIA - Saint Anastasia Catholic Church

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

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

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

Date of Birth: REQUIRED Please fill out this field. Please enter valid data.

Place of Birth: (City, State, Country) REQUIRED Please fill out this field. Please enter valid data.

Father's Name: REQUIRED Please fill out this field. Please enter valid data.

Mother's full Maiden Name: REQUIRED Please fill out this field. Please enter valid data.

Contact Information

Mailing Address: REQUIRED Please fill out this field. Please enter valid data.

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.

Cell/Mobile Phone: REQUIRED Please fill out this field. Please enter valid data.

Occupation: Please enter valid data.

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

Religious History

What, if any, is your present religious affiliation? REQUIRED Please fill out this field. Please enter valid data.

Have you ever been baptized? REQUIRED Please fill out this field.

If yes, in what denomination were you baptized? Please enter valid data.

Date or approximate age when you were baptized: Please enter valid data.

Baptismal name (if different from current name): Please enter valid data.

Place of Baptism (name of church/denomination): Please enter valid data.

Location/Address if known: Please enter valid data.

If you were Baptized Catholic, please select all sacraments that you have already received: REQUIRED Confession First Holy Communion Confirmation N/A Please fill out this field.

Current Marital Status

Check the appropriate statement(s) below. REQUIRED I have never been married. I am engaged to be married. I am married. I am married, but separated from my spouse. I am divorced and I have not remarried. I am a widow/widower and have not remarried. Please fill out this field.

Engaged

If Engaged, your Fiance(e)'s Name: Please enter valid data.

If Engaged, your Fiance(e)'s Current Religious Affiliation (if any): Please enter valid data.

If Engaged, has your Fiancé(e) been previously married? Please enter valid data.

If Yes, how many times? Please enter valid data.

Marriage

If Married, Date of Marriage: Please enter valid data.

If Married, Place of Marriage: Please enter valid data.

If Married Your Wedding Ceremony was:

Is this your first marriage? Please enter valid data.

If no, how many times have you been previously married? Please enter valid data.

If Married, your Spouse's Name: Please enter valid data.

If Married, your Spouse's Religious Affiliation (if any); Please enter valid data.

If Married, has your spouse been previously married? Please enter valid data.

If Yes, How many times? Please enter valid data.

Family Information
Please list the name(s) of any children or other dependents

Name Please enter valid data.

Relationship & Age Please enter valid data.

Name Please enter valid data.

Relationship & Age Please enter valid data.

Name Please enter valid data.

Relationship & Age Please enter valid data.

General Questions

What or who has led you to want to know more about the Catholic Faith? REQUIRED Please fill out this field.

Please describe the types of religious education you have received, as a child and as an adult. REQUIRED Please fill out this field.

What contact have you had with the Catholic Church to date? REQUIRED Please fill out this field.

What are some of the questions or concerns you have about the Catholic Church? REQUIRED Please fill out this field.

At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church? (please check one) REQUIRED Need more info about the Faith before I would consider joining. I am considering joining, but I am still unsure about it. I still need some time to study and pray about it. I am sure I want to join the Catholic Church. Please fill out this field.