RCIA Form

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Contact Information *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP code *

Home Phone

Mobile Phone

Email Address *

Date of Birth *

Month

Day

Year

City & State of Birth *

Father's Name *

Father's Religion *

Mother's Name (including Maiden Name) *

Mother's Religion *

Were you ever Baptized? *

Yes

Church of Baptism *

City & State of Church of Baptism *

Date of Baptism *

Month

Day

Year

Denomination/Religion of Baptism *

Were you ever Confirmed? *

Yes

Church of Confirmation *

City & State of Church of Confirmation *

Date of Confirmation *

Month

Day

Year

Have you received First Eucharist? *

Yes

Church of First Eucharist *

City & State of Church of First Eucharist *

Date of First Eucharist *

Month

Day

Year

Have you received First Reconciliation? *

Yes

Church of First Reconciliation *

City & State of Church of First Reconciliation *

Date of First Reconciliation *

Month

Day

Year

Are you presently married? *

Yes

Name of Spouse *

Name of Church where married *

City & State of Church where married *

Date of Marriage *

Month

Day

Year

Denomination of Marriage *

Were you ever previously married? *

Yes

Name of Spouse *

Date of Marriage *

Month

Day

Year

Name of Church where married *

City & State of Church where married *

Denomination of Marriage *

Date & Place of Dissolution *

Was this ever annulled in the Catholic Church? *

Yes

Currently in the process

Was your present &/or previous spouse ever married prior to your marriage? *

Yes

Name of Spouse *

Place of Marriage *

City & State *

Date of Marriage *

Month

Day

Year

Date & Place of Dissolution *

Was this ever annulled in the Catholic Church? *

Yes

Currently in the process

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