Parish Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Main Household Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Alternate Cell Number Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Spouse/Significant Other (First & Last Name) Please enter valid data.

Spouse/Significant Other Cell Number Please enter valid data.

Spouse/Significant Other Email Please enter valid data.

Names/Birth Dates of Children Living at Home Please enter valid data.

I would like to receive weekly contribution envelopes Yes No

I would like to participate in electronic giving Yes No

Catholic Community
of San Agustín