Name of Head of Household *

First Name

Last Name

Birthdate

MM

DD

YYYY

Sacraments Received *

Baptism

1st Communion

Confirmation

Marriage

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

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###

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Would you like to use complimentary contribution envelopes? *

Online giving is also available

Yes

No

Would you like to receive the Texas Catholic Newspaper? *

The Texas Catholic is a bi-monthly newspaper published by the Diocese of Dallas

Yes

No

Does anyone in your household have special needs or a disability?

This information helps us to serve you best.

Yes

No

Name of Spouse

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage

Name of Member 1

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage

Name of Member 2

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage

Name of Member 3

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage

Name of Member 4

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage

Name of Member 5

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Sacraments Received

Baptism

1st Communion

Confirmation

Marriage