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Family Information
Parish
*
St. Rose of Lima, Topsfield
St. Agnes, Middleton
My family is not registered at a parish. We would like to register at St. Rose.
My family is not registered at a parish. We would like to register at St. Agnes.
My family is registered at another parish and we do not plan to change parishes. (Please list your parish.)
Parish My family is registered at another parish and we do not plan to change parishes. (Please list your parish.)
Parent 1
First Name
*
Last Name
*
Maiden Name (if parent 1 is mother)
Address
*
Address 1
Address 2
City
State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
Illinois
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Maryland
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
--
Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
Home Phone
Cell Phone
*
Email
*
Check here if this parent would like more information about volunteering.
Please considering sharing your time and talent!
Parent 2
First Name
Last Name
Maiden Name (if parent 2 is mother)
Address (if different from Parent 1)
Country
- None -
United States
Address 1
Address 2
City
State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
--
Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
Home Phone (if different from Parent 1)
Cell Phone
Email
Check here if this parent would like more information about volunteering.
Please considering sharing your time and talent!
Emergency Contact (to call after trying both parents)
Full Name
*
Relation to Child(ren)
*
Emergency Contact Phone
*
Children
Child 1
First Name
*
Middle Name
Last Name
*
Sex
*
Male
Female
Date of Birth
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
*
- Select -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
*
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
Child 2
First Name
Middle Name
Last Name
Sex
Male
Female
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
- None -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
Child 3
First Name
Middle Name
Last Name
Sex
Male
Female
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
- None -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
Child 4
First Name
Middle Name
Last Name
Sex
Male
Female
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
- None -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
Child 5
First Name
Middle Name
Last Name
Sex
Male
Female
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
- None -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
Child 6
First Name
Middle Name
Last Name
Sex
Male
Female
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Grade (2021-2022)
- None -
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Has child been baptized?
Yes
No
Date of Baptism
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Year
Place of Baptism
If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Upload
Files must be less than
10 MB
.
Allowed file types:
gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml
.
Please list any health concerns, allergies, special needs, learning disabilities, anxieties, family circumstances, etc. that we should be aware of.
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