Parish Registration Form

Submitter Information

Thank you for registering or updating your existing registration with Infant Jesus parish of Port Jefferson. Our parishioners are the most treasured part of our parish, and we are always seeking ways in which we can serve them better. Having the proper information on hand to assist them in all matters, from the mundane to the spiritual, is vitally important to us. This form will ask a series of questions about your general family contact information and also about each member of your household. We appreciate the time it takes for you to fill out the form as completely as possible.

If your household is blessed with more than six members, simply fill out a second copy of this form. The first and second pages will be filled with the same information so we can identify you as the same household, but then you can add your remaining household members.

First, please let us know how to contact you in case we have any questions about your registration and so we can send you confirmation notices.

Enter full name(*)
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Enter e-mail address.(*)
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Enter phone number(*)
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Have you registered with us in the past?

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If known, enter your Envelope ID number.
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Basic Household Contact Information

On this page of the form we are asking you to give us basic contact information. Note: For address, please use the street address. There is a place for preferred mailing address, and even for an alternate address for those who spend part of the year away. Also, please be sure to include a general contact e-mail address.
Enter your family last name.(*)
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Enter your home street address (Line 1)(*)
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Enter your home street address (Line 2).
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Enter your home address city.(*)
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Enter your home address state.(*)
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Enter home address zip-code.
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Do you have a separate mailing address?
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Enter your mailing street address (Line 1).
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Enter your mailing street address (Line 2).
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Enter your mailing address city.
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Enter your mailing address state.
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Enter you mailing address zip-code.(*)
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Are you away for an extended period every year?
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Enter the particulars of departure and return dates, alternate address and any other pertinent information.
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Enter Home Phone Number(*)
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Enter Primary Family Cell Number(*)
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Enter Primary Family E-Mail Address(*)
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Would you like to be a part of our Spanish Community and Ministries?
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Head of Household Registration

For our records one person must be listed as the Head of Household. For the purposes of our database system, this is typically the husband. Otherwise, please enter the information of the person most responsible for the house hold.

Also, please list all your children, even if they no longer live in your household.

Enter Last Name(*)
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Enter First Name(*)
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Enter Middle Name
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Enter preferred Nickname if any
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Select Title

Invalid Input

Enter Title Prefix
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Select Title Suffix

Invalid Input

Enter Title Suffix
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Select Gender

Invalid Input

Enter Maiden Name
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Select Marital Status(*)

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Enter Marital Status
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Select Relationship to Head of Household (or Spouse)

Invalid Input

Enter Relationship to Head of Household
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Would This Person Consider Themselves As An Active Member Of Our Parish?

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For example: Typically this is for children who have, as adults, moved out of the home. Also they may be a member of another faith group. Remember, they are always welcome here in our parish as members, or to join us at any of our events, ministries etc.

Enter Personal Cell Phone Number
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Enter Work Phone Number
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Enter Personal E-Mail Address
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Select Religious Affliliation(*)

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Enter Religious Affiliation
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Enter Date of Birth(*)
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Enter Level of Education
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Enter Occupation
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Enter Special Needs
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For example: wheelchair user, visually impaired, mobility issues

Enter Your Involvment in Parish Activities
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Describe or List involvement in Parish Ministries, Volunteering, Groups, Activities and Events

Enter Any Comments That Would Help Us Serve You Better
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Are There More Members In Your Household?

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You must select either 'Yes', 'No' or 'Navigate to Another Page' to continue entering information into this form.

Please help us reduce SPAM.(*)
Please help us reduce SPAM.
RefreshInvalid Input

 

Spouse or Household Member 2 Information

Please enter registration information for the second person of the household.

Also, list all your children, even if they no longer live in your household. Is, you may mark them as not active in this parish.

Enter Last Name
Invalid Input

Enter First Name
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Enter Middle Name
Invalid Input

Select Title Prefix

Invalid Input

Enter Title Prefix
Invalid Input

Enter prefered Nickname if any
Invalid Input

Select Title Suffix

Invalid Input

Enter TItle Suffix
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Select Gender

Invalid Input

Enter Maiden Name if Different
Invalid Input

Select Marital Status

Invalid Input

Enter Marital Status
Invalid Input

Select Relationship (To Head of Household)

Invalid Input

Enter Relationship to Head of Household
Invalid Input

Would This Person Consider Themselves As An Active Member Of Our Parish?

Invalid Input

For example: Typically this is for children who have, as adults, moved out of the home. Also they may be a member of another faith group. Remember, they are always welcome here in our parish as members, or to join us at any of our events, ministries etc.

Enter Personal Cell Phone Number
Invalid Input

Enter Work Phone Number
Invalid Input

Enter Personal E-Mail Address
Invalid Input

Select Religious Affliliation

Invalid Input

Enter Religious Affiliation
Invalid Input

Enter Date of Birth
/ / Invalid Input

Enter Level of Education
Invalid Input

Enter Occupation
Invalid Input

Enter Special Needs
Invalid Input

For Example wheelchair user, visually impaired, mobility issues...

Enter Your Involvment in Parish Activities
Invalid Input

Describe or List involvement in Parish Ministries, Volunteering, Groups, Activities and Events

Enter Any Comments That Would Help Us Serve You Better
Invalid Input

Are There More Members In Your Household?

Invalid Input

You must select either 'Yes', 'No' or 'Navigate to Another Page' to continue entering information into this form.

 

Household Member 3 Information

Please enter registration information for the third person of the household.

Also, list all your children, even if they no longer live in your household. Is, you may mark them as not active in this parish.

Enter Last Name
Invalid Input

Enter First Name
Invalid Input

Enter Middle Name
Invalid Input

Enter preferred Nickname, if any
Invalid Input

Select Title Prefix

Invalid Input

Enter Title Prefix
Invalid Input

Select TItle Suffix

Invalid Input

Enter Title Suffix
Invalid Input

Select Gender

Invalid Input

Enter Maiden Name if Different
Invalid Input

Select Marital Status

Invalid Input

Enter Marital Status
Invalid Input

Select Relationship (To Head of Household)

Invalid Input

Enter Relationship (To Head of Household)
Invalid Input

Would This Person Consider Themselves As An Active Member Of Our Parish?

Invalid Input

For example: Typically this is for children who have, as adults, moved out of the home. Also they may be a member of another faith group. Remember, they are always welcome here in our parish as members, or to join us at any of our events, ministries etc.

Enter Personal Cell Phone Number
Invalid Input

Enter Work Phone Number
Invalid Input

Enter Personal E-Mail Address
Invalid Input

Select Religious Affliliation

Invalid Input

Enter Religious Affiliation
Invalid Input

Enter Level of Education
Invalid Input

Enter Date of Birth
/ / Invalid Input

Enter Occupation
Invalid Input

Enter Special Needs
Invalid Input

For Example wheelchair user, visually impaired, mobility issues...

Enter Your Involvment in Parish Activities
Invalid Input

Describe or List involvement in Parish Ministries, Volunteering, Groups, Activities and Events

Enter Any Comments That Would Help Us Serve You Better
Invalid Input

Are There More Members In Your Household?

Invalid Input

You must select either 'Yes', 'No' or 'Navigate to Another Page' to continue entering information into this form.

 

Household Member 4 Information

Please enter registration information for the fourth person of the household.

Also, list all your children, even if they no longer live in your household. Is, you may mark them as not active in this parish.

Enter Last Name
Invalid Input

Enter First Name
Invalid Input

Enter Middle Name
Invalid Input

Enter preferred Nickname, if any
Invalid Input

Select TItle Prefix

Invalid Input

Enter Title Prefix
Invalid Input

Select Title Suffix

Invalid Input

Enter Title Suffix
Invalid Input

Select Gender

Invalid Input

Enter Maiden Name if Different
Invalid Input

Select Marital Status

Invalid Input

Enter Marital Status
Invalid Input

Select Relationship (To Head of Household)

Invalid Input

Enter Relationship (To Head of Household)
Invalid Input

Would This Person Consider Themselves As An Active Member Of Our Parish?

Invalid Input

For example: Typically this is for children who have, as adults, moved out of the home. Also they may be a member of another faith group. Remember, they are always welcome here in our parish as members, or to join us at any of our events, ministries etc.

Enter Personal Cell Phone Number
Invalid Input

Enter Work Phone Number
Invalid Input

Enter Personal E-Mail Address
Invalid Input

Select Religious Affiliation

Invalid Input

Enter Religious Affiliation 4
Invalid Input

Enter Date of Birth
/ / Invalid Input

Enter Level of Education
Invalid Input

Enter Occupation
Invalid Input

Enter Special Needs
Invalid Input

For Example wheelchair user, visually impaired, mobility issues...

Enter Your Involvment in Parish Activities
Invalid Input

Describe or List involvement in Parish Ministries, Volunteering, Groups, Activities and Events

Enter Any Comments That Would Help Us Serve You Better
Invalid Input

Are There More Members In Your Household?

Invalid Input

You must select either 'Yes', 'No' or 'Navigate to Another Page' to continue entering information into this form.

 

Household Member 5 Information

Please enter registration information for the second person of the household.

Also, list all your children, even if they no longer live in your household. Is, you may mark them as not active in this parish.

Enter Last Name
Invalid Input

Enter First Name
Invalid Input

Enter Middle Name
Invalid Input

Enter preferred Nickname, if any
Invalid Input

Select Title Prefix

Invalid Input

Enter Title Prefix
Invalid Input

Select Title Suffix 5

Invalid Input

Enter Title Suffix
Invalid Input

Select Gender

Invalid Input

Enter Maiden Name if Different
Invalid Input

Select Marital Status

Invalid Input

Enter Marital Status
Invalid Input

Select Relationship (To Head of Household)

Invalid Input

Enter Relationship (To Head of Household)
Invalid Input

Enter Personal Cell Phone Number
Invalid Input

Enter Work Phone Number
Invalid Input

Enter Personal E-Mail Address
Invalid Input

Select Religious Affiliation

Invalid Input

Enter Religious Affiliation
Invalid Input

Enter Date of BIrth
/ / Invalid Input

Enter Level of Education
Invalid Input

Enter Occupation
Invalid Input

Enter Special Needs
Invalid Input

For Example wheelchair user, visually impaired, mobility issues...

Enter Your Involvment in Parish Activities
Invalid Input

Describe or List involvement in Parish Ministries, Volunteering, Groups, Activities and Events

Enter Any Comments That Would Help Us Serve You Better
Invalid Input

You have reached the end of this form. If you are blessed with additional members of your household that you were unable to list here, after submitting this form, please fill out the "Member Update Form" for each person not listed here.

Would This Person Consider Themselves As An Active Member Of Our Parish?
Invalid Input

For example: Typically this is for children who have, as adults, moved out of the home. Also they may be a member of another faith group. Remember, they are always welcome here in our parish as members, or to join us at any of our events, ministries etc.