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Adult Census Form

* Indicates required field

Name *

First

Last

Middle Name *

Maiden Name (if applicable) *

Nick Name (if applicable) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Head of Household *

Birthday *

If spouse is not Catholic, do you want to include their name on mailings? *

yes no

Gender *

Male Female

Phone Number (home) *

Phone Number (mobile) *

Phone Number (work) *

In case of an emergency contact: NAME *

Emergency Contact Phone *

Emergency Contact Relation *

Occupation *

Place of Employment *

Retired? *

yes no

Marital Status *

Single Married Widowed Seperated Divorced Divorced-Remarried

If married or re-married please fill out the following questions:

Date: *

Church *

City / State *

Religion *

Convert to the Roman Catholic Faith? *

yes no

Would you like to become a Catholic? *

yes no

Religious Education *

Baptism (Church) *

Baptism Church (City/State) *

First Communion (Church) *

First Communion Church (City/State) *

Confirmation (Church) *

Confirmation Church (City/State) *

Special Needs: *

I would like to receive the Holy Redeemer Weekly E-newsletter: *

yes no

I would like to be a part of the following:

Special Skills/Hobbies

(choose any of the talents listed below) *

Church Cleaning Music Landscaping/Plant Care Art Carpentry Painting Photography/Videography Plumbing Electrical Accounting Clerical/Secretarial Child Care Computer Technology Graphic Design/Web Design Culinary Arts/Catering

Organizations/Commissions

(check all you are interested in) *

Parish Council Education Commission Worship & Spiritual Life Commission Community Involvement Commission Finance Commission Parent Teacher Organization Athletic Club St. Vincent de Paul Quilting Summer Fest Commission Knights of Columbus Adoration Chapel Committee Scrip (gift card program) Stewardship Committee Tap & Cork Committee Boy Scouts/Girl Scouts

Ministries

(check all you are interested in) *

RCIA Lector Eucharistic Minister Usher Greeter Bereavement Lunch Music Ministry Prayer Chain Legion of Mary (Outreach Ministry) High School Youth Ministry Jr. High School Youth Ministry Walking With Purpose Catholics Returning Home Evangelization Religious Education Teaching Vacation Bible School

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Location

Contact Us

Holy Redeemer Catholic Church
918 W. Mill Rd.
Evansville, IN 47710

Office: (812) 424-8344
FAX: . (812) 424-7166