St. Louis Catholic Church

First name:

Middle name:

Last name:

Maiden name (if applicable):

Date of birth:

Age:

Place of birth:

Name of Father:

Name of Mother:

Street address:

New Field:

Cell phone:

Email:

(1) Present religious affiliation:

(2) Have you ever been baptized? If yes, please answer questions (a) through (f)

Yes

No

Not sure

(a) In what denomination?

(b) Date or approximate age when baptized?

(c) Baptismal name?

(d) Place of Baptism (name of church/denomination)?

(e) Address, if known:

(f) Location, if known:

(3) If you were baptized as a Catholic, check those sacraments you have already received:

Penance (Confession)

Eucharist (First Communion)

Confirmation

(1) Have you ever been married?

Yes

No

(2) Are you engaged to be married? (if yes, answer questions (a) through (d).

Yes

No

(a) Fiance(e)'s name:

(b) Fiance(e)'s current religious affiliation:

(c) For you:

This is my first marriage.

I have been married before.

(d) For your fiance(e):

This is his/her first marriage.

My fiance(e) has been married before.

(3) I am married. (If yes, answer questions (a) through (g).

Yes

No

(a) Spouse's name:

(b) Spouse's current religious affiliation:

(c) For you:

This is my first marriage.

I have been married before.

(d) For your spouse:

This is his/her first marriage.

My spouse has been married before.

(e) Date of marriage:

(f) Place of marriage:

(g) Officiating Authority of Marriage:

(4) I am married, but separated from my spouse.

Yes

No

(5) I am divorced, and I have not remarried.

Yes

No

Option 3

(6) I am a widow/widower and have not remarried since my spouse's death.

Yes

No

Family Information (list the names, relationship and age of any children or other dependents)

What or who has led you to want to know more about the Catholic Faith?

Please describe the types of religious education you have received, as a child and as an adult.

What contact have you had with the Catholic Church to date?

What are some of the questions or concerns you have about the Catholic Church?

At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church?

I need much more information about the Catholic Church before I would consider joining.

I am considering joining, but I am still unsure about it.

I am fairly sure that I would like to join, but I still need some time to study and pray about it.

I am fairly sure that I want to join the Catholic Church.

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