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Our Lady of the Assumption Catholic Church

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Registration Form

Registration Form

Contact Information

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New Parishioner(s)

Update for current parishioner(s)

Family Name*

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Self: First and Last Name, Gender and Date of Birth*

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Spouse: First and Last Name, Gender and Date of Birth*

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Maiden Name*

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Marital Status*

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Married

Single

Widowed

Divorced

Address

Street Address*

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City*

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State*

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Zip/Postal*

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Email

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Like to receive parish bulletin by email?

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Yes

No

Self: Mobile Phone

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Spouse: Mobile Phone

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Home Phone*

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Work Phone

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Self: Religion*

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Roman Catholic

Other:

Spouse: Religion*

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Roman Catholic

Other:

Self: Occupation

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Spouse: Occupation

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Number of Years in Parish*

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0 - 5 years

5 - 15 years

15 - 25 years

25 - 50 years

Over 50 years

Preference for giving

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Envelopes

Online

Please enter child's Name, Gender, Date of Birth in that order, separated by commas.

Child One: Name, Gender, Date of Birth

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Child Two: Name, Gender, Date of Birth

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Child Three: Name, Gender, Date of Birth

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Child Four: Name, Gender, Date of Birth

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Confirmation Email

Confirmation Email *

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Our Lady of the Assumption Church

435 Berkeley Ave, Claremont, CA 91711 Phone: (909) 626-3596

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