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Join Our Parish

- Join Our Parish

Please complete the census form below to register as a parishioner.
Census Form
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- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Church primarily attended? REQUIRED Please fill out this field.
- Physical 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.
- Mailing 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.
- Primary Phone REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Do you currently receive contribution envelopes? REQUIRED Yes No Please fill out this field.
- If yes, please enter your current envelope number. Please enter valid data.
- If no, would you like to begin receiving envelopes? Yes No
- Please consider signing up for Online Giving by visiting the "Give" tab on our website homepage. REQUIRED I will sign up today! I have already signed up! I would rather not give online. Please fill out this field.
- Number of Family Members REQUIRED Please fill out this field.
  
  Family Member 1
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 2
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 3
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 4
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 5
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 6
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 7
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 8
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 9
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 10
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 11
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
  
  Family Member 12
  
  Head of Household/Spouse/Child/Single Adult in Household REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Married by Priest Married Civilly Single Divorced Separated Widowed Please fill out this field.
  
  If married, what is your date of marriage? (mm/dd/yyyy) Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Work Phone Please enter valid data.
  
  If a student, name of school currently attending? Please enter valid data.
  
  If a student, current grade level? Please enter valid data.
  
  Will this family member attend CCD? REQUIRED Please fill out this field.
  
  Please check the box for each Sacrament received. (Select all that apply.) Baptism Reconciliation First Communion Confirmation Marriage
Submit

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St. John the Evangelist &
St. Margaret Catholic Church

Mermentau and Estherwood, LA

Join Our Parish

Census Form