Church of the Resurrection
Registration Form
First Name:________________________________ Title:
Mr.
Ms.
Mrs.
Dr.
Other ________
Spouse:___________________________________ Title:
Mr.
Ms.
Mrs.
Dr.
Other ________
Street Address: ;_____________________________________________
City/ST: ______________________________Zip: ________-_________
Carrier Route: ______
(if different)
Mailing Address:_____________________________________________
City/ST: ______________________________Zip: ________-_________
Carrier Route: ______
Primary Phone:(____) ____-______ Unlisted Type: (Voice, Fax, Beeper, Etc.) _____________
Second Phone:(____) ____-______
Unlisted
Type: _____________ Marital Status: Church Married Married Single Single Parent Separated Divorced Widow/er Other _________________
Remarks:_______________________________________________________________________________________________________
2nd Residence Address:_______________________________________ City/ST:
______________________________ Zip: ________-_________
Carrier Route: ______ 2nd Res. Phone:(____) ____-______ Unlisted or Type: (Voice, Fax, Beeper, Etc.) _____________
What dates are you at the 2nd Residence? From: Mo. ____ Day ____ To: Mo. ____ Day ____
Send mail to 2nd Residence during that time?
Yes
No2nd Residence Remarks: __________________________________________________________________________________
Print and fill out for each member (including those listed above) fill in the information below.
Member Name: ______________________________________Title:
Mr.
Ms.
Mrs.
Dr.
Other _______
Address Mail as:_______________________________________
Suffix:
Jr.
Sr.
II
III
Other ________
Member Type:
Head
Head 2
Spouse
Adult
Young Adult
Child
Foster
Other _______
Marital Status:
Church Married
Married
Single
Single Parent
Separated
Divorced
Widow/er
Other _______
Religion:
Catholic
Other ___________
Disability: ___________________________
Ethnicity: ______________________
Language: ___________________________
Occupation: _______________________________________________ If retired, please check here
, but note previous occupation.
Location: ______________________________________
Business Phone:(____) ____-______ Ext: ______ or Type: (Voice, Fax, Beeper, Etc.) _____________
Second Phone:(____) ____-______ Ext: ______ or Type: _____________
Date of Birth: ___/___/___Gender:
Male
Female
Highest Grade Achieved: __________Remarks: _______________________________________________
|
Baptism: |
Confirmation: |
Marriage: |
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| Date:___/___/___ | Location | Date: ___/___/___ | Location | Date: ___/___/___ | Location |
| Here, at this Church | Church | Here, at this Church | Church | Here, at this Church | Church |
| Yes Approximately | Address | Yes Approximately | Address | Yes Approximately | Address |
| Unsure | City/ST, | Unsure | City/ST, | Unsure | City/ST, |
| No | Zip | No | Zip | No | Zip |
|
1st Communion: |
Penance: |
Death: |
|||
| H, Y, A, U, N | H, Y, A, U, N | H, Y, A, U, N | |||
| Date: ___/___/___ | Location | Date: ___/___/___ | Location | Date: ___/___/___ | Location |
|
Liturgies
- Weekend Eucharist: Saturday - 5:30 PM and Sunday - 10:30 AM 3501 Cedar Lane, Portsmouth, VA 23703 ~ 757/484-7335 ~ 757/484-5857 info@reschurch.com |
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