RCIA Registration Form Online | THE CHURCH OF ST. FRANCIS XAVIER

RCIA 2021-2022 Registration Form
Name (First Name-Middle Name-Maiden Name-Last Name): *
Birth Date *

Month Day Year
Place of Birth: *
Father's Name (First Name-Middle Name-Last Name):
Mother's Name (First name-Middle Name-Maiden Name-Last Name):
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number:

Area Code Phone Number
Work Phone Number:

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
E-Mail Address: *
What, if any, is your present religious affiliation? *
Have you received the Sacrament of Baptism? *
Have you received the Sacrament of Reconciliation? *
Have you received the Sacrament of the Eucharist? *
If you have received the Sacrament of Baptism
Date of Baptism:

Month Day Year
Religion/Denomination:
Church of Baptism:
Church Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
If you have received the Sacrament of Confirmation
Date of Confirmation:

Month Day Year
Religion/Denomination:
Church of Confirmation:
Church Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Other information
Do you have a sponsor? *
Sponsor Information

Please provide the following information as soon as you decide who will be your sponsor
Sponsor’s Full Name

First Name Middle Name Last Name
Sponsor’s E-mail
Sponsor’s Phone Number

Area Code Phone Number
Saint Information

Please provide the name of your patron or patroness Saint as soon as you select one
Name of the Saint
Message:
Should be Empty:

RCIA 2021-2022 Registration Form

If you have received the Sacrament of Baptism

If you have received the Sacrament of Confirmation

Other information

Sponsor Information

Saint Information