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Head of Household
*
First
Middle
Last
Date and Place of Birth
*
Date and Place of Baptism (if applicable)
Date and Place of First Communion (if applicable)
Date and Place of Confirmation (if applicable)
Date and Place of Marriage (if applicable)
Date and Place of Holy Orders: (if applicable)
Is Our Lady of Peace...
*
Your Primary Parish?
You Secondary Parish?
Preferred Method of Donations
*
Pre-Authorized Debit
Envelopes
Cash
E-transfer
Home Address
*
Town
*
Postal Code
*
Mailing Address if different than Home Address:
Email Address
*
Primary Phone Number
*
Secondary Phone Number
*
Date Place Number
Number of Household Members
Selected Value:
0
Enter all household members:
*
Last, First, Middle Name: Relation to Head of Household: Gender ( ): Date of Birth: Place of Birth: Date and Place of Baptism: Date and Place of First Communion: Date and Place of Confirmation: Date and place of Marriage: Date and Place of Holy Orders: School: Grade: Email Address: Primary Phone #:
Additional Comments or Needs
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