Our Lady of the Assumption/Registration/Peshastin, WA

Family Last Name Please enter valid data.

Home phone #: Please enter valid data.

HOUSEHOLD INFORMATION

Adult #1 First and Last Name: Please enter valid data.

Marital Status: Single Married

Gender: M F

Occupation: Please enter valid data.

Email: Please enter valid data.

Cell #: Please enter valid data.

Street Address: Please enter valid data.

P.O. Box: Please enter valid data.

City: Please enter valid data.

Zip: Please enter valid data.

Adult #2 First and Last Name: Please enter valid data.

Marital Status Single Married

Gender: M F

Occupation: Please enter valid data.

Email: Please enter valid data.

Cell #: Please enter valid data.

Seasonal Street Address/P.O. Box (if applicable): Please enter valid data.

City & State: Please enter valid data.

Zip: Please enter valid data.

CHILDREN INFORMATION
(IF LIVING AT HOME)

Name of Child & Sacraments Received: Please enter valid data.

MINISTRY INVOLVEMENT OR INTEREST

Eucharistic Minister Yes

Lector Yes

Usher Yes

Greeter Yes

Music Yes

Religious Education Yes

Church Cleaning Yes

Coffee Hour Yes

Building Committee Yes

Parish Council or Finance Committee Yes

Knights of Columbus Yes

Other Yes

Please describe: Please enter valid data.

Would you like to receive envelopes for your contribution to the parish? Yes No

Our Lady of the Assumption