Parish Registration

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Parish Ministries
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Basilica School

Parish Registration

Parish Registration Form

We're so happy that you've chosen to join our faith family!

Parish Registration Form

Type of Registration

New Parishioner Registration

Current Parishioner Update

Family Surname

Date

Street Address

City

State

Zip

Do you live in the area year round or seasonally?

Year Round

Seasonally

May we share your personal information with our Parish Ministries?

Yes

No

Preferred Language

English

Spanish

1st Head of Household - Marital Status

Single

Married

Separated

Divorced

Widowed

1st Head of Household - First Name

1st Head of Household - Last Name

1st Head of Household - Primary Phone Number

1st Head of Household - Additional Phone Number

1st Head of Household - Email Address

Receive Parish Emails?

Yes

No

1st Head of Household - Date of Birth

1st Head of Household - Occupation

1st Head of Household - Sacraments Completed

Baptism

1st Communion

Confirmation

1st Head of Household - Church of Baptism

City

State

Additional Notes (If Applicable)

2nd Head of Household - Marital Status

Single

Married

Separated

Divorced

Widowed

2nd Head of Household - First Name

2nd Head of Household - Last Name

2nd Head of Household - Primary Phone Number

2nd Head of Household - Additional Phone Number

2nd Head of Household - Email Address

Receive Parish Emails?

Yes

No

2nd Head of Household - Date of Birth

2nd Head of Household - Occupation

2nd Head of Household - Sacraments Completed

Baptism

First Communion

Confirmation

2nd Head of Household - Church of Baptism

City

State

Additional Notes (If Applicable)

3rd Household Member - First Name

3rd Household Member - Last Name

3rd Household Member - Date of Birth

3rd Household Member - Occupation

3rd Household Member - Sacraments Completed

Baptism

1st Communion

Confirmation

3rd Household Member - Church of Baptism

City

State

Additional Notes (If Applicable)

4th Household Member - First Name

4th Household Member - Last Name

4th Household Member - Date of Birth

4th Household Member - Occupation

4th Household Member - Sacraments Completed

Baptism

1st Communion

Confirmation

4th Household Member - Church of Baptism

City

State

Additional Notes (If Applicable)

5th Household Member - First Name

5th Household Member - Last Name

5th Household Member - Date of Birth

5th Household Member - Occupation

5th Household Member - Sacraments Completed

Baptism

1st Communion

Confirmation

5th Household Member - Church of Baptism

City

State

Additional Notes (If Applicable)

I would like to learn more about:

Religious Education

Faith Formation

Sacraments

Music Ministry

Men's Ministry

Women's Ministry

Youth Ministry

Children's Ministry

Vacation Bible School

Event Volunteering

Extraordinary Ministers

Prayer Chain

Other

If Other, please specify

Thank you for contacting us.
We will get back to you as soon as possible

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Contact us

386-252-5422

317 Mullally Street,

Daytona Beach, FL 32114

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