Rite of Christian Initiation of Adults Registration Form (RCIA)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

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.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mobile Phone Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Place of Birth - City and State REQUIRED Please fill out this field. Please enter valid data.

Mother's Name (Maiden) REQUIRED Please fill out this field. Please enter valid data.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Have you been baptized? You will be asked to provide a copy of the Baptismal Certificate at first session. Yes No

If YES, please provide Denomination Please enter valid data.

Name and Address of Church of Bapitsm

Were you raised a specific Religion/Denomination? Please list which one. REQUIRED Please fill out this field.

Please check all that apply REQUIRED Single Married Divorced Remarried Living with someone in a romantic relationship If REMARRIED, married by a Catholic Priest Please fill out this field.

If Divorced or Remarried, how many times have you been married? Please enter valid data.

Have you ever received a marraige Annulment from the Catholic Church? Yes No

Sponsor for RCIA candidates must meet the following criteria:

A registered parishioner of a Catholic Church
Confirmed Catholic
If married, married by a Catholic priest
If single, not living with anyone in a romantic relationship
Is free to receive the Eucharist at Mass
Cannot be a spouse or parent of candidate

Do you have a Catholic Sponsor? If so, please provide name and contact information. REQUIRED Please fill out this field. Please enter valid data.