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

RCIA 2024-2025 Registration Form
Name (First Name-Middle Name-Maiden Name-Last Name):*
Birth Date*

MonthDayYear
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

CityState / Province

Postal / Zip CodeCountry
Home Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Cell Phone Number:

Area CodePhone 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:

MonthDayYear
Religion/Denomination:
Church of Baptism:
Church Address:

Street Address

Street Address Line 2

CityState / Province

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

MonthDayYear
Religion/Denomination:
Church of Confirmation:
Church Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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 NameMiddle NameLast Name
Sponsor’s E-mail
Sponsor’s Phone Number

Area CodePhone 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 2024-2025 Registration Form

If you have received the Sacrament of Baptism

If you have received the Sacrament of Confirmation

Other information

Sponsor Information

Saint Information