St. Luke’s Parish Registration Card

(Confidential)

Date________________________________

Family (last) Name________________________________________________

Address__________________________________________________________________________________________________

Street Apt. # City Zip Code

Telephone_________________________________ # of years attending St. Luke’s________________________

(All registered families will receive envelopes)

Head of Household (circle one): married separated divorced widowed single

Family Residence (circle one): own rent

total household income (optional)_____________ Primary language spoken at home:________________

Are there any special skills or interests you would be willing to share with the parish community (for example: maintenance, finance, teaching, administration)? _______________________

________________________________________________________________________________________________

______________________________________________________________________________________________

(over)

Please

List only those living with you date Baptism Confirmation occupation

(include last name, if different) of birth yes/no yes/no or school

Head

of household: _______________ __________ ________ ___________ _____________

Spouse: ______________________ __________ ________ ___________ _____________

Children: ______________________ __________ ________ ___________ _____________

______________________ __________ ________ ___________ _____________

______________________ ___________ ________ ___________ _____________

______________________ ___________ ________ ____________ _____________

______________________ ____________ ________ ____________ _____________

Others living with you & relationship to head of household

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Is anyone in your home chronically ill or homebound? Yes No

If yes, would you like a call from our health or visitation ministry? Yes no

THANK YOU FOR CHOOSING ST. LUKE’S AS YOUR PARISH!