ST. JUDE CATHOLIC CHURCH

Kapolei, Hawaii

Registration

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PARISH REGISTRATION FORM

To register your family*please fill out the request beloW*THEN CLICK SUBMIT
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- PRIMARY CONTACT INFO
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Birth Date REQUIRED Please fill out this field. Please enter a date.
- SPOUSE INFO
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Birth Date REQUIRED Please fill out this field. Please enter a date.
- MAILING ADDRESS
- STREET, APT 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.
- DEPENDENTS (18 & UNDER)
- 1ST DEPENDENT Please enter valid data.
- 2ND DEPENDENT Please enter valid data.
- 3RD DEPENDENT Please enter valid data.
- 4TH DEPENDENT Please enter valid data.
- DONATION ENVELOPE REQUEST REQUIRED Yes No Please fill out this field.
- NOTES: (ADD MORE DEPEDENTS HERE)
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