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Registration

- Faith Formation

Family registration form provided below. Please read our bulletin for additional detail. Or call the office for further information, 570-759-8113.
The maximum number of form submissions has been reached. This form is currently not available.
- Welcome Family Members:
  
  Family Surname (Father's/Parent 1 Name Below): Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's/Parent 1 Religion: Please enter valid data.
  
  Father's/Parent 1 Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father's/Parent 1 Email & Current Address Below: REQUIRED Please fill out this field. Please enter an email address.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Mother's Maiden Name (Mother's/Parent 2 Name Below): Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's/Parent 2 Religion: Please enter valid data.
  
  Mother's/Parent 2 Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email & current Address Below: REQUIRED Please fill out this field. Please enter an email address.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of Marriage or None: Please enter valid data.
  
  Date of Marriage or None (Church Address Below): Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of Current Registration or None: Please enter valid data.
- Additional Family Members: REQUIRED Please fill out this field.
  
  Legal Resident/Child: 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Legal Resident/Child: 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date Please enter a date.
  
  Church of Baptism or None: Please enter valid data.
  
  Date of Baptism & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church of First Penance or None: Please enter valid data.
  
  Date of First Penance & Location Below: REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Church Of Confirmation, Bishop's Name or None: Please enter valid data.
  
  Date Of Confirmation & Location Below: Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
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Immaculate Conception of the Blessed Virgin Mary Church

Berwick, PA (Under Construction)

Registration