Other Household Members

Name of Parish REQUIRED Christ the King / Abingdon St. John the Evangelist / Marion Please fill out this field.

Complete this form separately for each Household Member other than the Head of Household.
The information you provide will be exclusively for church use.

FAMILY INFORMATION (to link to the proper Head of Household)

LAST NAME REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

This household member is: REQUIRED a child an adult Please fill out this field.

FULL NAME (First / Middle / Maiden / Last) REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Female Male Other Please fill out this field.

Current Marital Status REQUIRED Single (never married) Married Catholic Married Other Divorced (not remarried) Widowed (not remarried) Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of Birth (City / State) Please enter valid data.

Ethnicity / Race REQUIRED Native American Caucasian / European African / African-American Hispanic / Latino Asian / Asian-American Native Hawaiian / Pacific Islander Other Please fill out this field.

Disability (Check all that apply) None Auditory / Hearing Learning / Neurobiological Physical / Motor Function Speech Visual

Catholic Sacraments received (Check all that apply) Baptism (Catholic / Christian) First Holy Communion Confirmation Marriage Holy Orders (permanent deacon) Holy Orders (priesthood)

Please review your responses before submitting this form. We appreciate as much accurate information as you are able to share with us. Thank you.

Christ the King & St. John the Evangelist

The Roman Catholic Parishes of Abingdon VA & Marion VA

Other Household Members