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  REGISTRATION FORM
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
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  Zip Please enter a zip code.
  
  Family Home Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Family Email Please enter valid data.
  
  Please check which Mass you normally attend: (Check all that apply) REQUIRED Saturday 4:30 p.m. Sunday 8:00 a.m. Sunday 10:30 a.m. Sunday 1:00 p.m. Please fill out this field.
  
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  Individual Information
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  Preferred Name Please enter valid data.
  
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  What Sacraments have you received? Baptized? First Communion? Confirmation?
  
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  Individual Information
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  Date and Place of Birth Please enter valid data.
  
  Ethnicity
  
  Marital Status
  
  Married in the Catholic Church (or with Church approval) Yes No
  
  What sacraments have you recieved? Baptized? First Communion? Confirmation?
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Business Phone Please enter valid data.
  
  Cell Phone Please enter valid data.
  
  Email Please enter an email address.
  
  How many children under the age of 21 live in your household? REQUIRED Please fill out this field.
  
  Child 1
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
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  First Communion REQUIRED Please fill out this field.
  
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  Confirmation REQUIRED Please fill out this field.
  
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  Child 2
  
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  Child 3
  
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  Child 4
  
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  Child 5
  
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  Confirmation REQUIRED Please fill out this field.
  
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  Child 6
  
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  Child 7
  
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  Child 8
  
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  Child 9
  
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  Child 10
  
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Jackson, Mississippi

Cathedral of st. peter the apostle

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