Click Submit Form to send this information to Saint Therese De Lisieux Catholic Church.

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*Registration Option Register a New Family Update an Existing Family *ID/Env:  
  Call Saint Therese De Lisieux Catholic Church at (561) 784-0689, if you do not know your ID Number or Envelope Number.
Head of Household
*Title *First Name *Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity *Birth Date *Gender Female   Male
Grade/Degree *Baptized   Language *Marital Status
*First Comm.
*Confirmation
*Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
Spouse
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Baptized   Language Marital Status
  First Comm.
  Confirmation
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP
Family Phone Numbers
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Email
*Email   Unlisted
Send Email Instead of Mail When Possible
Member 1   Type  
Title   First Name   Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Baptized   Language Marital Status
  First Comm.
  Confirmation
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted

Click Submit Form to send this information to Saint Therese De Lisieux Catholic Church.

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