Immaculate Heart of Mary Parish, Lansing at 3815 S Cedar St., Lansing, MI 48910-4501 US

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Year of Prayer
September 2009 - August 2010

Rejoice in the Lord always.
Present your needs to God in every form of
prayer and petitions full of gratitude.
Phillipians 4;4,6b

Parish Registration Form

Family Information

Last Name *
Preferred Mailing Title *
Address *
Apt. #
City *
State *
Zip *
Phone *
Email *
Verify Email *

Adults (18 & Over) Adult 1

First Name		Married by Priest	Yes No
Last Name		Wedding Date
Gender		Baptized	Yes No
Date of Birth		Confirmed	Yes No
Marital Status		Occupation
Catholic	Yes No	Work Phone
Ethnicity

Adult 2

First Name		Married by Priest	Yes No
Last Name		Wedding Date
Gender		Baptized	Yes No
Date of Birth		Confirmed	Yes No
Marital Status		Occupation
Catholic	Yes No	Work Phone
Ethnicity

Adult 3

First Name		Married by Priest	Yes No
Last Name		Wedding Date
Gender		Baptized	Yes No
Date of Birth		Confirmed	Yes No
Marital Status		Occupation
Catholic	Yes No	Work Phone
Ethnicity

Persons under 18 Child 1

First Name		Baptized	Yes No
Last Name		First Comm	Yes No
Gender		First Penance	Yes No
Date of Birth		Confirmed	Yes No
Catholic	Yes No	School Attended
Ethnicity		Current Grade

Child 2
First Name		Baptized	Yes No
Last Name		First Comm	Yes No
Gender		First Penance	Yes No
Date of Birth		Confirmed	Yes No
Catholic	Yes No	School Attended
Ethnicity		Current Grade

Child 3
First Name		Baptized	Yes No
Last Name		First Comm	Yes No
Gender		First Penance	Yes No
Date of Birth		Confirmed	Yes No
Catholic	Yes No	School Attended
Ethnicity		Current Grade

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Immaculate Heart of Mary Parish, Lansing at 3815 S Cedar St., Lansing, MI 48910-4501 US - Parish Registration Form