Parish Registration Form

163 Whisconier Rd., Brookfield, CT 06804 · (203) 775-1035

Test version. Nothing is sent to the parish office yet. Submitting shows a summary of what would be received.

Please fill in all the information that applies to your household. Fields marked * are required.

1 Registration

Type of registration

New registration Re-registration / update

Date

Last name

First name(s)

Mailing name

Address

Address line 2

City

State

Zip

Home phone

Emergency phone

Family email

Offertory giving

Yes, I would like to receive envelopes No, I will give through Online Giving

List yourself first. Then add your spouse and any other adults who live in the household, such as a partner, parent or adult child.

Marital status

Are you interested in speaking with a priest?

Yes No

Add each child living in your household. Leave this section empty if it does not apply.

Each adult in the household can answer separately.

Please provide changes when necessary. Questions? Call the Parish Office at (203) 775-1035.