RCIA Request Form

Your Information

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 & Province REQUIRED Please fill out this field. Please enter valid data.
Postal Code REQUIRED Please fill out this field. Please enter valid data.
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 valid data.
Place of Birth REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Parish attending: REQUIRED Blessed Sacrament St. Agnes St. Joseph St. Ursula Our Lady of Victory Please fill out this field.

Baptism Information

Date of Baptism (if baptized in any religion) Please enter valid data.
Denomination of Baptism (Catholic, Anglican, United, etc) Please enter valid data.
Church and City of Baptism (if baptized) Please enter valid data.

Your Parent's Information

Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
Father's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.
Mother's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.

Relationship & Family Information

Marital Status REQUIRED Never Married Married Common Law Separated/Divorced Please fill out this field.
Spouse's Name (if applicable) Please enter valid data.
Spouse's Birth Date (if applicable) Please enter valid data.
Date of Marriage (if married) Please enter valid data.
City and Church/Location of Marriage (if married) Please enter valid data.
Names and Birthdates of Children (if applicable)