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OCIA Registration Form

- About

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- Date REQUIRED Please fill out this field. Please enter a date.
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (if applicable) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Place of Birth (City, State): REQUIRED Please fill out this field. Please enter valid data.
- Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Contact Info: 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- What, if any, is your present religious denomination? REQUIRED Please fill out this field. Please enter valid data.
- Have you ever been baptized? REQUIRED Please fill out this field.
- If you answered yes to the question above, please provide the following information:
- In what denomination were you baptized? Please enter valid data.
- Place of Baptism (Name of Church and Location) Please enter valid data.
- If you were baptized Catholic, please check the sacraments you have already received: Penance (Confession) Eucharist (First Communion) Confirmation
- Current Marital Status: (You must provide a copy of marriage certificate, civil divorce decree, and annulment). Check the appropriate statements(s) below and provide any information requested beneath the statements(s).
- Marital Status REQUIRED Please fill out this field.
- If engaged, please answer the following:
- Fiancé's Full Name Please enter valid data.
- Fiancé's Current Religious Affiliation (if any): Please enter valid data.
- For your fiancé:
- For you:
- If married, please answer the following:
- For your spouse:
- For you:
- Date of current marriage Please enter a date.
- Place of current marriage Please enter valid data.
- Children
- Child One (Name, Age, Relationship): Please enter valid data.
- Child Two (Name, Age, Relationship): Please enter valid data.
- Child Three (Name, Age, Relationship): Please enter valid data.
- Child Four (Name, Age, Relationship): Please enter valid data.
- Child Five (Name, Age, Relationship): Please enter valid data.
- Additional Children (Name, Age, Relationship):
- General Questions
- Please describe your own religious education or church background: REQUIRED Please fill out this field.
- How have you come to be interested in the Roman Catholic Church? REQUIRED Please fill out this field.
- Do you have any questions that you would like answered at this time? REQUIRED Please fill out this field.
- Is there one person in particular who is responsible for your interest in the Catholic Church? Will that person be acting as your sponsor, and walking this journey with you? If yes, please provide name. REQUIRED Please fill out this field. Please enter valid data.
- (Sponsor must be 16 years of age or older, a Confirmed Catholic, attending Mass, and actively participating in the sacramental life of the Catholic Church).
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The Parishes of
Saint Jude & Our Lady of Lourdes

Columbiana & East Palestine, Ohio

OCIA Registration Form

If engaged, please answer the following:

If married, please answer the following:

Children

General Questions