122 Oregon Road
Cortlandt Manor, NY

Parishioner Registration Form

- Information

Welcome to the St. Columbanus Parish Family.

Please use the online form below to register with our parish, you may register as an individual (18 and over) or as a family. Registrant information is requested first, followed by spouse, and children.

You should review the form as to what information is being requested before entering the data. All information is entered at one time. Once submitted, it cannot be updated or added to without a visit to the office.

Please scroll to the bottom of the form when you are ready to submit the completed form. If any omissions are found they will be displayed in red.

You will be contacted to confirm your registration. Feel free to arrange a visit with one of the priests or deacons of the parish.

Thank you for taking the time to register! We are looking forward to meeting you.
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- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- Mailing Address: REQUIRED Please fill out this field. Please enter valid data.
- Line 2 Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Email Please enter an email address.
- Martital Status REQUIRED Married Single Widowed Separated Divorced Please fill out this field.
- Please enter the registration information for the first spouse or head of household:
  
  Title REQUIRED
  Please enter your Title. If "Other", then please enter the title on the line marked.Other
  Dr. Mr. Mrs. Ms. Other - Please complete Other below Please fill out this field.
  
  Other Title Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Religion if other than Catholic Please enter valid data.
  
  Occupation Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Marriage REQUIRED Yes No Please fill out this field.
  
  Marriage Date MM/DD/YYYY Please enter valid data.
  
  Was your marriage celebrated or blessed in the Catholic Church? Yes No
- Please enter the registration information for the second spouse:
  
  Title
  Please enter your Title. If "Other", then please enter the title on the line marked.Other
  Dr. Mr. Mrs. Ms. Other - Please complete Other below
  
  Other Title Please enter valid data.
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Gender Male Female
  
  Religion if other than Catholic Please enter valid data.
  
  Occupation Please enter valid data.
  
  Baptized Yes No
  
  First Holy Communion Yes No
  
  Confirmation Yes No
  
  Marriage Yes No
  
  Marriage Date MM/DD/YYYY Please enter valid data.
  
  Was your marriage celebrated or blessed in the Catholic Church? Yes No
- Children REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
  
  Child 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth MM/DD/YYYY Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Other Religion Please enter valid data.
  
  Baptized REQUIRED Yes No Please fill out this field.
  
  Baptized Date if known MM/DD/YYYY Please enter valid data.
  
  Church Baptized Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  First Holy Communion REQUIRED Yes No Please fill out this field.
  
  First Holy Communion Date if known MM/DD/YYYY Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Confirmation Date if known MM/DD/YYYY Please enter valid data.
Submit

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St. Columbanus Catholic Church

Cortlandt Manor, New York

Parishioner Registration Form