St. Theodore Catholic Church Census
St. Theodore Catholic Church
Post Office Box 12726
Lake Charles, La. 70612
(337)-855-6662
www.mossbluffcatholic.org
DATE: _________PLEASE CIRCLE PREF:
CONTRIBUTION ENVELOPES
You may:
a.) mail this form to us,
b.) FAX it to 855-6663,
c.) bring to the Church Office,
d.) put it in the Sunday collection.
YES /
NO
or
ONLINE GIVING (see website)
Please help us to update our Church Census by filling out the following information on all persons living at your address.
Are You a New Parishioner?
Yes
No
We are currently attending Church at:
Last Name
Person #1
Person #2
Person #3
Person #4
Person #5
St. Theodore
St. Pius
First Name
Mailing Address
Home Phone
Zip Code
Primary Cell
Date of Birth
Person #1
Person #2
Person #3
Person #4
Person #5
M
M
M
M
M
Yes
Yes
Yes
Yes
Yes
List Religion Baptized
Date
Church Name
M/M
Active
(Include City and State)
Date Married
Church Name
(Include City and State)
Married Separated Divorced Widowed Single
Married Separated Divorced Widowed Single
Married Separated Divorced Widowed Single
Married Separated Divorced Widowed Single
Married Separated Divorced Widowed Single
First Communion?
Person #1
Person #2
Person #3
Person #4
Person #5
Grade
No
No
No
No
No
Marital Status --CIRCLE ONE
Person #1
Person #2
Person #3
Person #4
Person #5
.
School or Occupation
(Example: Catholic, Baptist, Methodist, Lutheran, Pentecostal)
Person #1
Person #2
Person #3
Person #4
Person #5
Zip Code
EMAIL ADDRESS:
Race
Baptized
Maiden Name
Physical Address (if different)
Secondary Cell
Sex
F
F
F
F
F
Other:
Middle Name
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
REG
WL
Confirmation?
Yes
Yes
Yes
Yes
Yes
Lector
Acolyte
Choir
Usher
No
No
No
No
No
ETH
ENV
Office Use Only
Pending
Database
RS
Page 1
Map Code
FILE
CCD
CDA
KC
Alter Society
St. Theodore Catholic Church Census
Last Name
First Name
Middle Name
Maiden Name
Person #6
Person #7
Person #8
Person #9
Date of Birth
Person #6
Person #7
Person #8
Person #9
M
M
M
M
Sex
F
F
F
F
Baptized
Race
School / Occupation
List Religion Baptized
Date
Church Name
(Example: Catholic, Baptist, Methodist, Lutheran, Pentecostal)
Person #6
Person #7
Person #8
Person #9
Yes
Yes
Yes
Yes
Person #6
Person #7
Person #8
Person #9
Married
Separated
Divorced
Widowed
Single
Married
Separated
Divorced
Widowed
Single
Married
Separated
Divorced
Widowed
Single
Married
Separated
Divorced
Widowed
Single
First Communion?
Yes
Yes
Yes
Yes
(Include City and State)
No
No
No
No
Marital Status
Person #6
Person #7
Person #8
Person #9
Grade
No
No
No
No
Date Married
Confirmation?
Yes
Yes
Yes
Yes
Lector
Acolyte
No
No
No
No
OTHER INFORMATION:
REVISED 2/8/2016
Page 2
Choir
Usher
Church Name (Include City and State)
CCD
CDA
KC
Alter Society