Welcome To Saint Teresa of Avila

Titusville, Florida

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Parishioner Online Registration

Interested in becoming a member of St. Theresa Catholic Church?  Please fill out the Parish Data Census/Registration Form below and we will be in contact with you.

FAMILY INFORMATION
HEAD OF HOUSEHOLD:	SPOUSE:
Last Name:	Last Name:
First Name:	First Name:
Title (Mr/Mrs/Ms/Miss):	Title (Mr/Mrs/Ms/Miss):
Suffix (Sr., Jr., III):	Maiden Name:
Maiden Name:
MAILING ADDRESS:
Address Line 1:
Address Line 2:
City:State: Florida Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Colombia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:
EMAIL ADDRESS:
Email Addr.(Head):
Email Addr.(Spouse):
PHONE (HEAD):	PHONE (SPOUSE):
Home:	Home:
Cell:	Cell:
Work:	Work:
HEAD OF HOUSE INFO:	SPOUSE INFO:
Marital Status: Single Catholic Marriage Civil Marriage Divorced Separated Widowed	Marital Status: Single Catholic Marriage Civil Marriage Divorced Separated Widowed
If Catholic Marriage:	If Catholic Marriage:
Church Name:	Church Name:
Church Addr.:	Church Addr.:
Performed By:	Performed By:
Language:	Language:
Ethnicity:	Ethnicity:
Religion:	Religion:
Occupation:	Occupation:
Gender: Male Female	Gender: Male Female
Birthday:	Birthday:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day : Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day:  Year:
Birthplace:	Birthplace:
Disability:	Disability:
Baptized:  Yes No	Baptized:  Yes No
First Communion:  Yes No	First Communion:  Yes No
Reconciliation (Penance):  Yes No	Reconciliation (Penance):  Yes No
Confirmation:  Yes No	Confirmation:  Yes No
Fingerprinted by Diocese of Orlando: Yes No	Fingerprinted by Diocese of Orlando: Yes No
I would like to volunteer the following skills: Enter your skills here	I would like to volunteer the following skills: Enter your skills here
I would like to volunteer for the following ministries: Enter ministries here	I would like to volunteer for the following ministries: Enter ministries here
Want to receive envelopes?: Yes No
Parent/Grandparent/Relative living with you?: If so, Name:
Ask a Pastoral Care Person to visit them?: Yes No
CHILDREN LIVING AT HOME:	CHILDREN LIVING AT HOME:
Baptismal Name:	Baptismal Name:
Gender: Male Female	Gender: Male Female
Birthday:	Birthday:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day:   Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day:   Year:
Birthplace:	Birthplace:
Baptized: Yes No	Baptized: Yes No
Baptized on:	Baptized on:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day:  Year:
Baptismal Date: Approx. Unsure	Baptized:  Approx. Unsure
Performed By:	Performed By:
Church Name:	Church Name:
Church Address:	Church Address:
1st Communion: Yes No	1st Communion: Yes No
First Communion Date:	First Communion Date:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:   Year:
1st Communion Date: Approx. Unsure	1st Communion Date: Approx. Unsure
Performed By:	Performed By:
Church Name:	Church Name:
Church Address:	Church Address:
Reconciliation (Penance): Yes No	Reconciliation (Penance): Yes No
Reconciliation Date:	Reconciliation Date:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:
Reconciliation Date:  Approx. Unsure	Reconciliation Date:  Approx. Unsure
Performed By:	Performed By:
Church Name:	Church Name:
Church Address:	Church Address:
Confirmation: Yes No	Confirmation: Yes No
Confirmation Date:	Confirmation Date:
Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:	Mo:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Day:  Year:
Confirmation Date: Approx. Unsure	Confirmation Date:  Approx. Unsure
Performed By:	Performed By:
Church Name:	Church Name:
Church Address:	Church Address: