FAMILY REGISTRATION

St. Thomas the Apostle Parish              Today's Date                              4300 King Springs Rd, SE • Smyrna, GA 30082-4214                             (770) 432-8579 • Fax (770) 432-8570

*Mailing Name (e.g. Mr.& Mrs. John Doe):

*Address:                    Apt/Lot:

*City:               *State: --Select a State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Non-US North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming     *Zip: -

*Home Phone:     *Emerg. Phone:

*Family Email:

Permission to publish phone, address, email in Parish Directory

Publish Phone? Publish Address? Publish Email?

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Individual Membership Information

Head of Household *First Name/Nickname: / *Last Name: Gender: Male / Female (Maiden) DOB(mmddyyyy): Email: Special Needs: Work Phone/Cell Phone: / First Language: Occupation: Education Level: Religion: Catholic  RCIA  Other If Other, Specify: Sacrament Info: Baptized? First Eucharist? Confirmed? Marital Staus (Single, Married, Separated, Divorced, Annulled):

Spouse / Male / Female (Maiden) / Catholic  RCIA  Other If Other, Specify: Baptised First Eucharist? Confirmed?

Married by Priest/Deacon

Wedding Date: (e.g. mm/dd/yyyy)

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Dependent Information

Relationship: First Name: Last Name: Gender: DOB (mmddyyyy): 1st Language: Ed. Level/Grade: Religion: Baptized?: Communion?: Confirmation?:	Male Female Yes No Yes No Yes No	Male Female Yes No Yes No Yes No	Male Female Yes No Yes No Yes No	Male Female Yes No Yes No Yes No
*** Please fill in all blank boxes. If additional members need to be added, please call the office at 770-432-8579 ***