St. John of the Cross Parish

ST. JOHN OF THE CROSS PARISH

140 Richmond Rd., Euclid, Ohio 44143

PERSONAL HOUSEHOLD INFORMATION Date: #______

Family Name: ______Address Mail to: Mr. & Mrs.  Mr.  Mrs.  Ms.  Miss  Other Street Address: Apt.#______City: State: Zip Code:______Phone: ______

MEMBER INFORMATION

Name: ______ Mr.  Mrs.  Ms.  Miss  Other

Gender:  Male  Female Birth Date:______

Maiden Name (if applicable):______

Relationship in Household:  Head of Household  Spouse  Child  Other______

Marital Status (check one):  Single  Married  Divorced  Annulment  Widowed______

Religion: ______Sacraments:  Baptized  1st Communion  Confirmed

PresentSchool: ______Grade: Attends PSR

Education Completed: Occupation:______

Work Phone: E-Mail Address:______

Cell Phone:______

Mass Usually Attended: Saturday  4:00pm Sunday  9:00am  11:00am ______

Special Needs:  Homebound  Nursing Home (specify name):______

Name:  Mr.  Mrs.  Ms.  Miss  Other

Gender:  Male  Female Birth Date:______

Maiden Name (if applicable):______

Relationship in Household:  Head of Household  Spouse  Child  Other______

Marital Status (check one):  Single  Married  Divorced  Annulment  Widowed______

Religion: ______Sacraments:  Baptized  1st Communion  Confirmed

PresentSchool: ______Grade: Attends PSR

Education Completed: Occupation:______

Work Phone: E-Mail Address:______

Cell Phone:______

Mass Usually Attended: Saturday  4:00pm Sunday  9:00am  11:00am ______

Special Needs:  Homebound  Nursing Home (specify name):______

ADDITIONAL MEMBER INFORMATION

Name:  Mr.  Mrs.  Ms.  Miss  Other

Gender:  Male  Female Birth Date:______

Maiden Name (if applicable):______

Relationship in Household:  Head of Household  Spouse  Child  Other______

Marital Status (check one):  Single  Married  Divorced  Annulment  Widowed______

Religion: ______Sacraments:  Baptized  1st Communion  Confirmed

PresentSchool: ______Grade: Attends PSR

Education Completed: Occupation:______

Work Phone: E-Mail Address:______Cell Phone:______

Mass Usually Attended: Saturday  4:00pm Sunday  9:00am  11:00am ______

Special Needs:  Homebound  Nursing Home (specify name):______

Name:  Mr.  Mrs.  Ms.  Miss  Other

Gender:  Male  Female Birth Date:______

Maiden Name (if applicable):______

Relationship in Household:  Head of Household  Spouse  Child  Other______

Marital Status (check one):  Single  Married  Divorced  Annulment  Widowed______

Religion: ______Sacraments:  Baptized  1st Communion  Confirmed

PresentSchool: ______Grade: Attends PSR

Education Completed: Occupation:______

Work Phone: E-Mail Address:______

Cell Phone:______

Mass Usually Attended: Saturday  4:00pm Sunday  9:00am  11:00am ______

Special Needs:  Homebound  Nursing Home (specify name):______

Name:  Mr.  Mrs.  Ms.  Miss  Other

Gender:  Male  Female Birth Date:______

Maiden Name (if applicable):______

Relationship in Household:  Head of Household  Spouse  Child  Other______

Marital Status (check one):  Single  Married  Divorced  Annulment  Widowed______

Religion: ______Sacraments:  Baptized  1st Communion  Confirmed

PresentSchool: ______Grade: Attends PSR

Education Completed: Occupation:______

Work Phone: E-Mail Address:______

Cell Phone:______

Mass Usually Attended: Saturday  4:00pm Sunday  9:00am  11:00am ______

Special Needs:  Homebound  Nursing Home (specify name):______