ST. JOHN THE BAPTIST CHURCH

CONFIDENTIAL CENSUS INFORMATION

HOUSEHOLD INFORMATION:

Last Name  ____________________________        Street Address  ______________________________________

City  __________________ Zip Code  _________    Telephone  _(______)_________________   Listed ( yes / no )

Email _______________________________________________________________________

PERSONAL INFORMATION:

     First     ______          Last     ________            Maiden   ________        Mar. Stat.  _       Birth date         Sex__

Husband:         ___________________________________________________________________________________

Wife:*             ___________________________________________________________________________________

Single Adults:* ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­  ___________________________________________________________________________________

 ___________________________________________________________________________________

 ___________________________________________________________________________________

Children:          ___________________________________________________________________________________

 ___________________________________________________________________________________

 ___________________________________________________________________________________

                (* Please give maiden name if married)

RELIGIOUS INFORMATION:         (if yes, please give dates if known)

  Religion  __     Baptized/Date __   Church __      City/State   __    First Comm./Date   __  Confirmed/Date __

Husband:         ____________Y / N____________________________Y / N______________Y / N__________

Wife:               ____________Y / N____________________________Y / N______________Y / N__________

Single Adult:    ____________Y / N____________________________Y / N______________Y / N__________

                      ____________Y / N____________________________Y / N______________Y / N__________

                      ____________Y / N____________________________Y / N______________Y / N__________

Children:         ____________Y / N____________________________Y / N______________Y / N__________

                      ____________Y / N____________________________Y / N______________Y / N__________

                      ____________Y / N____________________________Y / N______________Y / N__________

Marriage Information:

Marriage Date________________   Church of Marriage     ______________________  City/State ______________

MISCELLANEOUS INFORMATION:            (answer only those which apply)

                 School __            Grade    __              Occupation (optional)      __          Interested In*________

Husband:        ___________________________________________________________________________________

Wife:               ___________________________________________________________________________________

Single Adult:   ___________________________________________________________________________________

 ___________________________________________________________________________________

Children:        ___________________________________________________________________________________

  ___________________________________________________________________________________

(* List any activities which you might be interested in: i.e.  Eucharistic Minister, Lector, Usher, Choir, Rel Ed Teacher, Adult Ed, RCIA, Altar Rosary, Catholic Men’s Group, Committees, etc.)