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Holy Name of Mary Parish
Family Registration Form
Name of Head of Household
*
First
Last
Phone Number
*
Cell Phone Number
*
Email
*
Date of Birth mm/dd/yyy
*
Address
*
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City
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Zip Code
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Would you like to receive bi-monthly offertory envelopes
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Name of Spouse/Partner
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Last
Phone Number
*
Cell Phone Number
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Email
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Date of Birth mm/dd/yyyy
*
Child #1
*
First
Last
Date of Birth mm/dd/yyyy
*
Gender
*
Male
Female
Child #2
*
First
Last
Date of Birth mm/dd/yyyy
*
Gender
*
Male
Female
Child #3
*
First
Last
Date of Birth mm/dd/yyyy
*
Gender
*
Male
Female
Child #4
*
First
Last
Date of Birth mm/dd/yyyy
*
Gender
*
Male
Female
Child #5
*
First
Last
Date of Birth mm/dd/yyyy
*
Gender
*
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Female
Submit Our Registration
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