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New Member Registration Form

Name

This field is for validation purposes and should be left unchanged.

Family Last Name(Required)

Phone(Required)

Unlisted(Required)

Yes

No

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Would you like to receive church envelopes or would you like to receive more information about online giving?(Required)

Church Envelopes

Online Giving Options

Marital Status(Required)

Single

Married

Divorced

Widowed

Member Information

Name(Required)

First Last

Phone(Required)

Unlisted(Required)

Yes

No

Email(Required)

Date of Birth(Required)

Email(Required)

Date(Required)

Religion

Baptized Date and Church/City(Required)

Confirmation Date and Church/City(Required)

Occupation

Place of Employment

Phone

Add Another Member(Required)

Yes

No

Additional Member

Name(Required)

First Last

Phone

Unlisted

Yes

No

Email

Date of Birth(Required)

Religion

Baptized Date and Church/City

Confirmation Date and Church/City

Occupation

Place of Employment

Phone

Children

Need to add Child(ren)?(Required)

Yes

No

Child

Name(Required)

First Last

M/F

Male

Female

Date of Birth

Baptism (Date/Church)

Confirmation (Date/Church)

Add Another Child?(Required)

Yes

No

Child #2

Name(Required)

First Last

M/F

Male

Female

Date of Birth

Baptism (Date/Church)

Confirmation (Date/Church)

Add Another Child?(Required)

Yes

No

In Case of Emergency Contact:

Name(Required)

First Last

Emergency Contact Phone #(Required)

Relationship(Required)

If you are coming to us from another parish, please list the name and be sure to call their office so they may update their records.

St. Francis Xavier is a Roman Catholic community in Mount Washington, Kentucky, established in 1846 to further God’s kingdom on earth. We are a welcoming community of faith serving the spiritual, emotional, intellectual and physical needs of our parishioners. We are dedicated to the celebration of the sacraments and the teachings of the church. Our goal is to meet these needs through various parish organizations and through community ministries.

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Contact

155 Stringer Ln, Mt Washington, KY 40047 Phone: 502-538-4933 Fax: (502) 955-0449

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