Become a Parishioner

Last Name (Apellido Paterno) REQUIRED Please fill out this field. Please enter valid data.

Street address (Domicillo) REQUIRED Please fill out this field. Please enter valid data.

City/State (Ciudad, Estado) REQUIRED Please fill out this field. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter an integer (number).

Email REQUIRED Please fill out this field. Please enter an email address.

Phone (Teléfono) REQUIRED Please fill out this field. Please enter a phone number.

2nd Phone# (2nd Teléfono) Please enter a phone number.

Marital status (Estado Civil) REQUIRED Please fill out this field.

Head of Household / Cabeza de Familia

First Name (Primer Nombre) REQUIRED Please fill out this field. Please enter valid data.
Last Name (Apellido) REQUIRED Please fill out this field. Please enter valid data.
Religion Please enter valid data.
Primary language at home (Principal idioma en casa) Please enter valid data.
Name of Employer (Patron) Please enter valid data.
Occupation (Occupación) Please enter valid data.
Work Phone (Telefono de Trabajo) Please enter valid data.
Date of Birth (Fecha de Nacimiento) REQUIRED Please fill out this field. Please enter a date.
Gender (Sexo) REQUIRED M F Please fill out this field.
Sacraments (Sacramentos) Baptized (Bautizado) Reconciliation (Primera Confesión) First Communion (Primera Comunión) Confirmed (Confirmación) Marriage (Matrimonio)
Date of Marriage (Fecha de Matrimonio) Please enter a date.

Spouse (Esposa)

First Name (Primer Nombre) Please enter valid data.
Last Name (Apellido) Please enter valid data.
Maiden name (Apellido de soltera) Please enter valid data.
Religion Please enter valid data.
Primary language at home (Principal idioma en casa) Please enter valid data.
Name of Employer (Patron) Please enter valid data.
Occupation (Occupación) Please enter valid data.
Work Phone (Telefono de Trabajo) Please enter valid data.
Date of Birth (Fecha de Nacimiento) Please enter a date.
Gender (Sexo) M F
Sacraments (Sacramentos) Baptized (Bautizado) Reconciliation (Primera Confesión) First Communion (Primera Comunión) Confirmed (Confirmación) Marriage (Matrimonio)

Our Lady of the Miraculous Medal Parish