RCIA

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Maiden Name (if applicable) Please enter valid data.

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 REQUIRED Please fill out this field. Please enter an email address.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

Father's Information

First Name Please enter valid data.

Last Name Please enter valid data.
Father's Religion Please enter valid data.

Mother's Information

First Name Please enter valid data.

Last Name Please enter valid data.
Mother's Maiden Name Please enter valid data.
Mother's Religion Please enter valid data.

Baptism Information

Have you ever been Baptized, immersed, or sprinkled in any religious rite? REQUIRED yes no unsure Please fill out this field.
If so, in what Christian denomination? Please enter valid data.
Name of the Church of Baptism Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Date of Baptism Please enter a date.

Current Marital Status REQUIRED Please fill out this field.

If married, were you married by a Priest/Deacon? yes no

Have you had an annulment? yes no

Reason for attending RCIA (select all that apply) REQUIRED I wish to become Catholic I wish to become a Sponor Im Catholic, but need to receive First Communion Im Catholic, but need to receive Confirmation Faith Enrichment Other (please explain below) Please fill out this field.

If other, please explain

Our Lady of Mount Virgin

Garfield, NJ

Rite of Chistian Initiation of Adults

RCIA Registration Form