Assumption of the Blessed Virgin Mary
In this Year of Faith we are asking all of our Community to assist our office in updating member registration
or in some cases register for the first time. Thank you for providing as much information as you wish to share.
Electronic form: Click on grey box to select or enter text. Use tab or mouse to advance to next field.
Date:
Check one:
Okay to publish our names in Bulletin
Please send envelopes
Yes
No
Year first join this parish (if known):
New Registration
Re-Registration
Yes
No
Members/Couple Information– please select
Marital Status:
Married
 In the Catholic Church?
Single (Never Married)
Separated
Member #1
Mr.
Mrs.
Ms.
Yes
No
Divorced
Member #2
Dr.
Widowed
Mr.
Mrs.
Ms.
Dr.
Name:
Name:
First
Maiden Name
Last
Suffix
Informal Name:
Date of Birth:
Sacrament Information– please select
Catholic?
Yes
No
Other Religion:
Baptized:
First Eucharist:
Confirmed:
Yes
No
Yes
No
Yes
No
Occupation:
Type of Business:
Self Employed?
Now Retired (indicate former occupation above)
Cell Phone #:
Email:
Special Needs:
First
Maiden Name
Last
Suffix
Informal Name:
Date of Birth:
Sacrament Information– please select
Catholic?
Yes
No
Other Religion:
Baptized:
First Eucharist:
Confirmed:
Yes
No
Yes
No
Yes
No
Occupation:
Type of Business:
Self Employed?
Now Retired (indicate former occupation above)
Cell Phone #:
Email:
Special Needs:
Household Information:
Home Phone:
Primary Email:
Address:
Mailing Address (if different):
City:
Zip:
Other Adults Residing In Home — College Students, Elderly, Dependent Adults…Use the space below.
Young Adults or Out of College—Please use separate form. Important to be a member (separate from parents)when it is time to plan your
wedding (here or at another Catholic church), become a Baptism or Confirmation sponsor.
Name:
Name:
First
Maiden Name
Last
Suffix
Informal Name:
Date of Birth:
Sacrament Information– please select
Catholic?
Yes
No
Other Religion:
Baptized:
First Eucharist:
Confirmed:
Yes
No
Yes
No
Yes
No
Marital Status: Married In the Catholic Church? Yes
No
Single (Never Married)
Separated
Divorced
Widowed
Occupation:
Type of Business:
Self Employed?
Now Retired (indicate former occupation above)
Cell Phone #:
Email:
Relationship to head of household:
Special Needs:
First
Maiden Name
Last
Suffix
Informal Name:
Date of Birth:
Sacrament Information– please select
Catholic?
Yes
No
Other Religion:
Baptized:
First Eucharist:
Confirmed:
Yes
No
Yes
No
Yes
No
Marital Status: Married In the Catholic Church? Yes
No
Single (Never Married)
Separated
Divorced
Widowed
Occupation:
Type of Business:
Self Employed?
Now Retired (indicate former occupation above)
Cell Phone #:
Email:
Relationship to head of household:
Special Needs:
Please continue on page 2 for listing of minor children and parish community participation— Thank you
Page 1 of 3
Office Use Only:
PDS _____
OSV_____
Pastor’s Ltr. ____
Page 2 of 3
Staff Welcome Ltr. _____
I.D. Number _________
Minor Children (under 18)
Name (first, middle, last, nickname)
Please Print Clearly
Relationship
Date of
Birth
Baptized?
First
Comm.?
Confirmed?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Special
Needs?
Other Relatives in Parish/Relationship:
Stewardship—Called by the Lord to Share Your Time, Talents & Treasure…
Gifts, Skills, Talents or Ministry Participation—ways you can share in the parish community
Member Name
Skills or Talents
Ministries
Currently Involved
Send Info
Member Name
Skills or Talents
Ministries
Currently Involved
Send Info
Member Name
Skills or Talents
Ministries
Currently Involved
Send Info
Member Name
Skills or Talents
Ministries
Currently Involved
Send Info
New Members Only:
Did someone refer you to this parish?
Yes
No
If yes, who?
Please tell us why you chose this parish:
Welcome to our Parish!
Please place in the Offering Basket or drop off/mail to Assumption BVM • 2640 E. Orange Grove Blvd. • Pasadena 91107
PHONE: 626/792-1343 • EMAIL: register@abvmpasadena.org • WEB SITE: www.abvmpasadena.org
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