Welcome to Saint Rose of Lima Catholic Church
 Parishioner Registration Form
 Bienvenido a nuestra hoja de Registracion

Click Submit Form to send this information to Saint Rose of Lima.

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*Required fields

*Registration Option Register a New Family Update an Existing Family *ID/Env:  

Head of Household
Title *First Name *Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity *Birth Date *Gender Female   Male
Grade/Degree   Language *Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Sacraments   Name Received Date Place
   Baptism
   Confirm
   First Comm
   Marriage
   Holy Order

Spouse
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Sacraments   Name Received Date Place
   Baptism