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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 Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email Please enter an email address.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Marital Status REQUIRED Please fill out this field.
- Emergency Contact Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Are you interested in any ministries? If so, please let us know. Maximum 100 characters Please enter valid data.
- 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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Date of Birth 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.
  
  What is their religion? REQUIRED Please fill out this field. Please enter valid data.
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ST. ANTHONY
CATHOLIC CHURCH

UPLAND, CA

Parish Registration