Join our Pastorate

REGISTRATION

Register our family at the following location (choose one): REQUIRED St. Mary of the Immaculate Conception, Portage St. John the Baptist, Montello St. Faustina, Pardeeville & Buffalo St. Mary Help of Christians, Briggsville Good Shepherd, Westfield Please fill out this field.

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

Street 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. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter valid data.

Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.

Previous Parish (Church name and location) Please enter valid data.

Would you like to receive the Catholic Herald Newspaper? $12 / 6 mo. subscription Yes - mail or drop off payment at the parish office No

Would you like to receive Giving Envelopes mailed directly to your home or do you prefer to give online? REQUIRED Mail envelopes to my home Give online Please fill out this field.

Would you like to sign up for Weekly Parish Flocknotes? (Newsletter delivered via email or text) REQUIRED Yes No Please fill out this field.

Members of Household (please include all family members)

HEAD OF HOUSEHOLD

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

Email REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Marital Status REQUIRED Please fill out this field.

Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony Holy Orders

Date each Sacrament was received (if known) Please enter valid data.

Church of Baptism (name, city, state) Please enter valid data.

Religion (if not Catholic) Please enter valid data.

Number of additional family members Please fill out this field.
Family Member 1
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 2
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 3
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 4
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 5
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 6
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.
Family Member 7
- First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Relationship to Head of Household REQUIRED Please fill out this field.
- Phone Number Please enter valid data.
- Email Please enter valid data.
- Sacraments Received Baptism Reconciliation First Holy Eucharist Confirmation Matrimony
- Date each Sacrament was received (if known) Please enter valid data.
- Church of Baptism (name, city, state) Please enter valid data.
- Religion (if not Catholic) Please enter valid data.