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RCIA & Adult Confirmation Registration

- Religious Education

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- Year Please enter valid data.
- Program REQUIRED RCIA Please fill out this field.
- Contact Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date of Birth
  MM/DD/YYYY
  Please enter valid data.
  
  Place of Birth
  City/State
  Please enter valid data.
  
  Father's Name
  First and Last
  Please enter valid data.
  
  Mother's Name
  First, Last, and Maiden
  Please enter valid data.
  
  Spouse's Name Please enter valid data.
  
  Emergency Contact Phone Number Please enter a phone number.
- Documents
  
  Baptized? REQUIRED Yes No Please fill out this field.
  
  Date and Place of Baptism Please enter valid data.
  
  First Holy Communion? REQUIRED Yes No Please fill out this field.
  
  Date and Place of First Holy Communion
  If Applicable
  Please enter valid data.
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