St. Patrick Catholic Church of Merna

1001 N. Towanda Barnes Road, Bloomington, IL 61705-5456
(Corner of IL Route 9 and Towanda-Barnes Road)
Phone: 309-662-7361
Fax: 309-664-6167

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Head of Household

Do you wish to join? Yes No Unsure 
Mr   Mrs 
Ms   Miss  Dr		 First Name
 Last Name
 Maiden Name
Nickname
Address
 City
 State
 Zip Code
Home Phone 
 Work Phone
 Cell Phone
 Email Address
Marital Status 
Catholic Church Marriage Married Single Widowed Separated Divorced Annulled Remarried
     Date Married (mm/dd/yyyy) Church    City/State
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation

Employer
 School Attend(ing)(ed)

Highest Grade/Degree
Baptized
(mm/dd/yyyy)

(Church/City/State)
 First Reconciliation
(mm/dd/yyyy)

(Church/City/State)
First Communion
(mm/dd/yyyy)

(Church/City/State)
Confirmation
(mm/dd/yyyy)

(Church/City/State)
Child(ren) will be a part of Religious Education Program (preschool - high school)

Child(ren) will be a attending of Parish School (Holy Trinity School is our associated parish school)

Please have someone from the school contact me.

Please list talent(s) you are willing to share with the parish if needed

Comments (Special needs or handicaps, language preferences or spoken, &/or information for over 6 children)

 

Spouse

 
First Name
 Last Name
 Maiden Name
Nickname
Home Phone 
 Work Phone
 Cell Phone
 Email Address
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
 School Attend(ing)(ed)

Highest Grade/Degree
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
  
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

 

Child

 
Name
 School Attend(ing)(ed)

Highest Grade/Degree
Gender
Male   Female		 Birth Date (mm/dd/yyyy)
 Religion
Handicap
 Languages Spoken
 Occupation/Employer
Baptized (mm/dd/yyyy)

(Church/City/State)
 First Reconciliation (mm/dd/yyyy)

(Church/City/State)
 First Communion (mm/dd/yyyy)

(Church/City/State)
 Confirmation (mm/dd/yyyy)

(Church/City/State)

Time Permitting, I would like to volunteer my services for:

Religious Education

     Pre-School
          Teacher
          Aide

     Grades 1-5
          Teacher (Grade )
          Aide (Grade )

     Youth Ministry (Grades 6-12)
          Teacher (Grade )
          Activities
          Chaperone
          Youth Ministry Committee

Liturgy
     Eucharistic Minister
     Minister of Hospitality
     Altar Server
     Art & Environment

Music
     Choir
     Folk Group
     Musician (Instrument )
     Song Leader

General

     Nursery Caregiver

     Building & Grounds Committee

     Finance Committee

     Hospitality Committee

     Clerical Worker (Occasional)

     Scripture Study Group

     Family Life

     Elizabeth Ministry

     Mom's Morning Out

     RCIA

     Other

     Yes, I would like to be contacted by our Welcome Ministry

     Yes, I received a Parish Ministry Handbook

    


Page Last Updated: 2005-10-02