in English - Holy Family Cluster
Holy Family Cluster Confidential Census Form Please fill out and return this form to: Holy Family Cluster Office 608 2nd Avenue NE Clarion, Iowa 50525 Or email to: dbq039sec@archdbq.org Or fax to: 515-532-2153 Dear Parishioner, Please take time to complete and return the following census form as early as possible. The information helps our Cluster and parishes plan more effectively for the needs of our parishioners. The following information is needed for our parishes’ census records. In addition, with the upcoming pictorial directory, we can ensure that your information is up to date and correct. Statistical information from the parish census records is also provided to the Archdiocese of Dubuque for planning the needs of the Archdiocese. The information you provide is confidential and is for the sole use of the Cluster and its parishes. If you prefer some or all of your contact information to remain private and not appear in the pictorial directory, please indicate such on the form. Please be sure to list all the members of your family who will be listed under your membership and answer questions to the best of your knowledge. Only include adult children if they are living at home or still in school. If they prefer to have their own membership, please have them fill out their own form. If you are no longer a member of the parish or attend elsewhere, please contact the office so we can remove you from our database. You will find instructions listed on the sheet, however, if you need additional help, please call the Cluster office at 515-532-3586 and we will be glad to assist you. Completed forms can be placed in the box located in the entry of each church during Mass. The box will be removed following each Mass to assure confidentiality. You may also drop off or mail your completed form to the Holy Family Cluster Office, 608 2nd Avenue NE, Clarion, Iowa 50525. In addition, you can email the form to dbq039sec@dbqarch.org or fax it to our office at 515-532-2153. Additional copies of this form can be found on the home page of our website (holyfamilycluster.org) or by contacting the Cluster office during business hours. God Bless, Fr. Jerry Blake and the Holy Family Cluster Staff Please circle your parish Sacred Heart Parish St. John Parish St. Francis Xavier Parish Contact Information Family Last Name:___________________________________ Address: (Street)_____________________________________ (City, State, Zip Code)______________________________ Home Phone (Landline only):___________________________ Family Email Address:_________________________________ For Office Use Only: Envelope Number:_____________________ Date Received:________________________ Your address and phone number are published in our Pictorial Directory. If you prefer certain parts of your contact information not be listed, please list that here:________________________________ Individual Member Information: Adults Adult Family Member #1 First Name/Nickname:____________________________ Cell Phone Number:______________________________ Maiden Name:____________ Gender: Female Occupation/Employer:____________________________ Role (Husband/Wife/Head of House):________________ Work Phone Number:_____________________________ Date of Birth:__________ Religion:_________________ If you are not Catholic, would you be interested in learning more about the faith? Yes No Marital Status:___________________________________ If married, date & location of marriage:______________ _______________________________________________ Ethnic Origin:_________ Primary Language:__________ Sacraments: Baptism (place/date if known):______________________ Confirmed? Yes No Male Email (Personal):________________________________ Mass Attendance (circle one): Daily Weekly Monthly Occasionally Seldom Holidays Adult Family Member #2 First Name/Nickname:____________________________ Cell Phone Number:______________________________ Maiden Name:____________ Gender: Female Occupation/Employer:____________________________ Role (Husband/Wife/Head of House):________________ Work Phone Number:_____________________________ Date of Birth:__________ Religion:_________________ If you are not Catholic, would you be interested in learning more about the faith? Yes No Marital Status:___________________________________ If married, date & location of marriage:______________ _______________________________________________ Ethnic Origin:_________ Primary Language:__________ Sacraments: Baptism (place/date if known):______________________ Confirmed? Yes No Male Email (Personal):________________________________ Mass Attendance (circle one): Daily Weekly Monthly Occasionally Seldom Holidays Individual Member Information: Children (If no children in the home, skip to last page) This includes all children in the household, as well as adult children who still live at home or are currently attending college. If you have an adult child living at home and they would like to be registered separately, please contact us and we will send you another form. Child #1 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Child #2 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Child #3 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Child #4 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Child #5 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Child #6 First Name / Nickname:____________________________ Gender: Male Female Current Age:_________ Date of Birth:____________ Religion:______________ Attends Youth Faith Formation Classes? Yes No Sacraments (Please include date and/or place if known): Baptism___________________________________ 1st Reconciliation___________________________ 1st Communion_____________________________ Confirmation_______________________________ Please use a separate sheet if you have additional children. Recall that the Holy Spirit has given each of us personal gifts to use for the building up the Christian community and our world. If you are interested in volunteering, currently volunteer or would like more information on one of the many opportunities listed below, please check all that apply and include the name of the family member. Please note, not all of these opportunities are available in each parish. FAITH FORMATION Youth Faith Formation Teacher ( ) _______________________________________ Youth Faith Formation Substitute Teacher ( ) _______________________________________ RCIA (Rite of Christian Initiation of Adults) Sponsor: ( ) _______________________________________ Team Member: ( ) _______________________________________ LITURGY Altar Server ( ) _______________________________________ Lector (Weekday or Weekend) ( ) _______________________________________ Usher (includes Greeting and Gift Bearer) ( ) _______________________________________ Extraordinary Minister of Holy Communion ( ) _______________________________________ Rosary Leader ( ) _______________________________________ Sacristan ( ) _______________________________________ MUSIC Cluster Choir ( ) _______________________________________ Cantor / Song Leader ( ) _______________________________________ Organist ( ) _______________________________________ Musician (please include instrument you play) ( ) _______________________________________ ADDITIONAL MINISTRIES & ORGANIZATION Communion Minister to the Homebound and Care Center ( ) _______________________________________ Parish Life Committee ( ) _______________________________________ Social Justice Committee ( ) _______________________________________ Stewardship Committee ( ) _______________________________________ Parish Leadership (determined by election) ( ) _______________________________________ Prayer Chain ( ) _______________________________________ Sewing Mission ( ) _______________________________________ Building/Grounds Committee ( ) _______________________________________ Cluster Fall Festival Committee ( ) _______________________________________ Mother Theresa Group ( ) _______________________________________ OTHER ABILITIES OR INTERESTS Please list any other interests or abilities you may have that you would be willing to share with your parish and Cluster. This might include youth group, office help, helping with parish dinners, cooking, general handyman skills, etc: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________
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