Registration Form
Tri-Parish Registration Form 2021-2022
Please copy below form and fill out the information and then: mail, email or give to:
Fr. Tom Huff
PO Box 35
Seneca , WI . 54654
frtomhuff@gmail.com
REGISTRATION FORM:
Which Parish are you Joining (Please check one):
St. Patrick in Seneca ____ St. Philip Parish in Rolling Ground ____
St. Mary in Gays Mills ____ Effective Date beginning: _____________
Would you like to receive contribution church envelopes? YES _____ NO _______
Husband: (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Home Phone: ____________________________ Mobile:_____________________________
Street Adddress:______________________________________________________________
City: _________________________________ State: _____________ Zip: _______________
Email: __________________________________
Baptized in what Faith?: ____________________________________________
Date of Birth: ___________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Wife: (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Home Phone: ____________________________ Mobile:_____________________________
Street Adddress:______________________________________________________________
City: _________________________________ State: _____________ Zip: _______________
Email: __________________________________
Baptized in what Faith?: ____________________________________________
Date of Birth: ___________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Minor Children who are still living at home and/or under your care:
(Independent adult children would register themselves at the Church where they are living and attending Mass)
Child 1 (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Relation to Head of Household: Child____ Stepchild____ Grandchild____ Other____
Baptized in what Faith: ___________________________________
Date of Birth: ______________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Child 2 (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Relation to Head of Household: Child____ Stepchild____ Grandchild____ Other____
Baptized in what Faith: ___________________________________
Date of Birth: ______________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Child 3 (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Relation to Head of Household: Child____ Stepchild____ Grandchild____ Other____
Baptized in what Faith: ___________________________________
Date of Birth: ______________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Child 4 (All names need to be legal, full names, no shorten or nicknames please)
First Name: ____________________________ Middle Name: ________________________
Last Name: ____________________________
Relation to Head of Household: Child____ Stepchild____ Grandchild____ Other____
Baptized in what Faith: ___________________________________
Date of Birth: ______________________________
Sacraments received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Sacraments not received in a Catholic Church: (Check all boxes that apply)
Baptism____ Reconciliation____ Holy Eucharist____ Confirmation____ Marriage____
Please mail, email or give to:
Fr. Tom Huff
PO Box 35
Seneca , WI . 54654
frtomhuff@gmail.com
