St. Jane Frances de Chantal
Catholic Church
(Pastorate parish with OLC)

8499 Virginia Ave.
Riviera Beach, Maryland 21122

www.stjane.org

www.stjane.org

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Parish Registration Form

- Parish Registration Form

Welcome to St. Jane Frances Parish! We are glad you are apart of our Parish community!
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- Household Contact Information
  (Enter information below for an adult in this household (over 21 or married person)
- Title REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name: REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (if female) REQUIRED Please fill out this field. Please enter valid data.
- Suffix
- Date of Birth: (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Place of Birth: REQUIRED Please fill out this field. Please enter valid data.
- Marital Status: REQUIRED Please fill out this field.
- Occupation REQUIRED Please fill out this field. Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- If Married, then when is your Anniversary? (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
- Home 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.
- Are you tranferring from another parish within the Archdiocese of Baltimore? REQUIRED Please fill out this field.
- How would you like to make a contribution to St. Jane Frances? REQUIRED Please fill out this field.
- Would you like to receive the Catholic Review Magazine? REQUIRED Please fill out this field.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Head of House #2
  (Enter information below for an adult in this household (over 21 or married person)
- Title
- Suffix
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Name: Please enter valid data.
- Maiden Name (if female) Please enter valid data.
- Email Please enter an email address.
- Cell Phone Maximum 20 characters Please enter a phone number.
- Date of Birth: (mm/dd/yyyy) Please enter valid data.
- Place of Birth: Please enter valid data.
- Occupation Please enter valid data.
- Religion Please enter valid data.
- Marital Status:
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
- Family Member #3
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Name: Please enter valid data.
- Suffix
- Gender
- Relation to Head of Household:
- If other, please explain: Please enter valid data.
- Date of Birth: (mm/dd/yyyy) Please enter valid data.
- Place of Birth: Please enter valid data.
- Religion: Please enter valid data.
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
- FAMILY MEMBER #4
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Name: Please enter valid data.
- Suffix
- Gender
- Relation to Head of Household:
- If other, please explain: Please enter valid data.
- Date of Birth: Please enter valid data.
- Place of Birth: Please enter valid data.
- Religion: Please enter valid data.
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
- FAMILY MEMBER #5
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Initial: Please enter valid data.
- Suffix
- Relation to Head of Household:
- If other, please explain: Please enter valid data.
- Date of Birth: Please enter valid data.
- Place of Birth: Please enter valid data.
- Religion: Please enter valid data.
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
- FAMILY MEMBER #6
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Initial: Please enter valid data.
- Suffix
- Relation to Head of Household:
- If other, please explain: Please enter valid data.
- Date of Birth: Please enter valid data.
- Place of Birth: Please enter valid data.
- Religion: Please enter valid data.
- Sacraments Received: Baptism 1st Communion Reconciliation Confirmation
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