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:* ___________________________________________________________________________________
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Children: ___________________________________________________________________________________
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(* 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: ___________________________________________________________________________________
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Children: ___________________________________________________________________________________
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(* 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.)