Parish Registration

- Thank you for taking the time to complete this form. We realize it does not cover all situations, but please fill it out as completely as possible and then click submit. If you have any questions or issues, please contact Courtland Wash in the parish office, who can further assist you. Additionally, paper forms are also available.
- Welcome to St. Pius X Catholic Church
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Are you currently registered with another parish?
  
  If yes, Please name the Parish Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  How would you like to do your stewardship donation? Online Envelopes
  
  Do we have permission to publish the following within the Parish? Phone Number Address Photo Email I do not want any of my information to be published.
  
  Would you like to receive the Catholic Virginian (newspaper)? Yes No
  
  Household Mailing Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Formal Salutation Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender Male Female
  
  Martial Status Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other
  
  If other: Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments Received Baptism 1st Communion Confirmation Marriage
  
  Sacrament Parish (Locations & Dates)
  
  Occupation Please enter valid data.
  
  Spouse / Other Adult
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Email Please enter an email address.
  
  Maiden Name Please enter valid data.
  
  Birth Date Please enter a date.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender Male Female
  
  Marital Status Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other
  
  If Other: Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments Received Baptism 1st Communion Confirmation Marriage
  
  Sacrament Parish (Locations & Dates)
  
  Occupation Please enter valid data.
  
  Children REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date Please enter a date.
  
  Role Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other (please specify)
  
  If other Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments received Baptism 1st Communion Confirmation None
  
  Sacrament Parish (Locations & Dates)
  
  Grade (rising) Please enter valid data.
  
  School Catholic Private Public
  
  Name of School Please enter valid data.
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date Please enter a date.
  
  Role Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other (please specify)
  
  If other Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments received Baptism 1st Communion Confirmation None
  
  Sacrament Parish (Locations & Dates)
  
  Grade (rising) Please enter valid data.
  
  School Catholic Private Public
  
  Name of School Please enter valid data.
  
  Child 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date Please enter a date.
  
  Role Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other (please specify)
  
  If other Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments received Baptism 1st Communion Confirmation None
  
  Sacrament Parish (Locations & Dates)
  
  Grade (rising) Please enter valid data.
  
  School Catholic Private Public
  
  Name of School Please enter valid data.
  
  Child 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date Please enter a date.
  
  Role Please enter valid data.
  
  Religion Please enter valid data.
  
  Race/Ethnicity Please enter valid data.
  
  Language (s) English Filipino Japanese Korean Spanish Vietnamese Other (please specify)
  
  If other Please enter valid data.
  
  Disability Please enter valid data.
  
  Sacraments received Baptism 1st Communion Confirmation None
  
  Sacrament Parish (Locations & Dates)
  
  Grade (rising) Please enter valid data.
  
  School Catholic Private Public
  
  Name of School Please enter valid data.
  
  Final Information
  
  Name of the Person completing this form REQUIRED Please fill out this field. Please enter valid data.
  
  Is this information: REQUIRED Brand New Information? An Update to a Current Household Listing? Please fill out this field.
  
  Submit
  
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