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- Date REQUIRED Please fill out this field. Please enter a date.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street 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.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email Please enter an email address.
- Marital Status REQUIRED Please fill out this field.
- People Living in the Household REQUIRED Please fill out this field.
  
  Person 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Person 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to you REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
- Emergency Contact Number REQUIRED Please fill out this field. Please enter a phone number.
- Are you interested in any ministries? If so, please let us know. Please enter valid data.
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ST. ANTHONY PARISH

UPLAND, CA

Parish Registration