St Michael's Catholic Church

Call: 519-433-6689|
E-mail: stmichlon@dol.ca|
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Registration Form

Select Registration type: New Registration. Update Registration.

Name & City of Former Parish:^*

Primary Member: Mr Mrs Ms Miss Dr.

First Name: ^*

Middle Name:

Last Name:^*

Date of Birth: ^*

Religion: ^* Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Address:^*

Apt./Unit:

Postal Code:^*

Telephone Number: ^*

Email:^*

Other Adult member: Mr Mrs Ms Miss

First Name:

Middle Name:

Last Name:

Date of Birth:

Religion: Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Relationship to primary member: Spouse Common Law other

Would you like any member of the pastoral team to contact you?: Yes Not at this time

Regarding:

Is there Other Adult Member in the Household? Yes No

Other Adult member: Mr Mrs Ms Miss

First Name: ^*

Middle Name:

Last Name:^*

Date of Birth: ^*

Religion: ^* Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Relationship to primary member: ^* spouse Common Law other

Number of children living at home:

Mark this field if you would like to receive newsletter communication from the parish. You will be able to unsubscribe at any time.

Primary Member: Mr Mrs Ms Miss Dr.

First Name: ^*

Middle Name:

Last Name:^*

Date of Birth: ^*

Religion: ^* Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Old Address:^*

New Address:^*

Apt./Unit:

New Postal Code:^*

Telephone Number: ^*

Email:^*

Other Adult member: Mr Mrs Ms Miss

First Name:

Middle Name:

Last Name:

Date of Birth:

Religion: Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Relationship to primary member: Spouse Common Law other

Would you like any member of the pastoral team to contact you?: Yes Not at this time

Regarding:

Are there other adult members in the household? Yes No

Other Adult member: Mr Mrs Ms Miss

First Name: ^*

Middle Name:

Last Name:^*

Date of Birth: ^*

Religion: ^* Roman Catholic other

Occupation:

Sacraments: Baptism Reconciliation First Communion Confirmation

Relationship to primary member: ^* spouse Common Law other

Number of children living at home:

Mark this field if you would like to receive newsletter communication from the parish. You will be able to unsubscribe at any time.

St.Michael's parish
511 cheapside street
London, on N5Y 3X5

TEL: 519-433-6689
FAX: 519-433-2301
E-MAIL: stmichlon@dol.ca

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