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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Date of birth REQUIRED Please fill out this field. Please enter a date.
Preferred Language Please enter valid data.
Sacraments Baptism First Reconciliation First Communion Confirmation
Baptized Catholic REQUIRED Yes No Please fill out this field.
If not Catholic, which Denomination Please enter valid data.
I need more information about Baptism, First Reconciliation, First Communion, or Confirmation. REQUIRED Yes No Please fill out this field.
Are you interested in becoming Catholic? Yes No Possibly - need more information
Are you active in another Church? Yes No
Occupation - include company and phone number
Are there any disabilities of which you would like us to be aware?
You are invited to share any other information about yourself or your family that you would like a member of our Pastoral Staff to know:
Would you be interested in any of the following? Prayer Group Retreats Bible Study MQ School Enrollment Children Religious/Sacramental Formation Music

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Mary Queen of the Holy Rosary