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    State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

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  • ADULTS IN HOUSEHOLD
  • Head of Household
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  • Baptized? Yes No
  • If yes, where? Church & City Please enter valid data.
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  • Communion? Yes No
  • Confirmed? Yes No
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  • In a Catholic Church? Yes No
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  • CHILDREN IN HOUSEHOLD
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    • Adults 1
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      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • Confirmed? Yes No
      • Date of Marriage Please enter valid data.
      • In Catholic Church Yes No
      • Mass Attendance Weekly Occasionally Seldom
      • Parish Ministries
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      • Requests or Needs
    • Adults 2
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      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • Confirmed? Yes No
      • Date of Marriage Please enter valid data.
      • In Catholic Church Yes No
      • Mass Attendance Weekly Occasionally Seldom
      • Parish Ministries
      • Envelope User Please enter valid data.
      • Requests or Needs
    • Adults 3
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      • Occupation Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • Confirmed? Yes No
      • Date of Marriage Please enter valid data.
      • In Catholic Church Yes No
      • Mass Attendance Weekly Occasionally Seldom
      • Parish Ministries
      • Envelope User Please enter valid data.
      • Requests or Needs
    • Adults 4
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      • Occupation Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • Confirmed? Yes No
      • Date of Marriage Please enter valid data.
      • In Catholic Church Yes No
      • Mass Attendance Weekly Occasionally Seldom
      • Parish Ministries
      • Envelope User Please enter valid data.
      • Requests or Needs
  • • Number of Children REQUIRED Please fill out this field.
    • Child 1
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      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 2
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        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Gender Male Female
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      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 3
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        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 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.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 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.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 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.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 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.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
    • Child 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.
      • Gender Male Female
      • DOB REQUIRED Please fill out this field. Please enter valid data.
      • Baptized? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Communion? Yes No
      • If yes, where? Church & City Please enter valid data.
      • Confirmation? Yes No
      • If yes, where? Church & City Please enter valid data.
      • School Attending Please enter valid data.
  • Church You Attend None Sacred Heart, Massena St. Lawrence, Louisville St. Joseph's, Massena St. Mary's, Massena
  • Suggestions for the Parish
  • I would like to be contacted by Pastor or Staff Member Yes No

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