QUEEN OF PEACE
CONFIDENTIAL PARISH REGISTRATION/CENSUS

New or Revised:	New Revised
Family last name:
Street address:
City, State, ZIP:	, ,
Telephone:
Email:
Language spoken at home:
Years in this parish:
Family residence:	------ Owner Tenant
Head of household:	------ Married Separated Divorced Widowed Single
You Wish to Receive Offering Envelopes:	------ No Yes
Wife's Maiden Name:

List those living with you (inc. last name if different)	Date of birth	Country of birth	Religion	Baptism	1st Com.	Confirm	Mass Attendance	Church Society	School, Occupation, Homebound
Husband:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Wife:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Child1:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Child2:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Child3:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Child4:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Child5:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Self:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Others living with you     How related
Other1:Relation:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending
Other2:Relation:				--- Yes No	--- Yes No	--- Yes No	------ Regular Intermittent Not Attending