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Family Registration Form

The Person/Family with intention of becoming member(s) of the Our Lady of Fatima Catholic Church, Inverness will complete and submit the Registration Form.

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Physical Address

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as Physical Address

Street Address Address Line 2 City State ZIP Code

Home phone

Cell Phone

Other Phone

E-Mail Address

Seasonal Resident?

Yes

No

MEMBER INFORMATION – Please fill out completely

Head of Household

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

Spouse

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

Child/ Other

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

Add another Child/Other?

Yes

No

Child/ Other

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

Add another Child/Other?

Yes

No

Child/ Other

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

Add another Child/Other?

Yes

No

Child/ Other

Name

First Last

Gender

Date of Birth

MM slash DD slash YYYY

Religion

Occupation

Marital Status

Sacraments Made?

Baptism

Communion

Confirmation

Select all that apply.

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Contact

550 U.S. Highway 41 S. Inverness, FL 34450 Phone: (352) 726-1670 Fax: (351) 344-8384

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