Saint Bernadette Catholic Church - Jesus Christ is the Heart of Bayou Vista, Louisiana

JSTM

Christ is the Heart of Bayou Vista, Louisiana

Parish Online Census Form

Thank you for taking the time to fill out our online census form.

Please note the following:

	When asked for location, if the Parish was not St. Bernadette Parish, please enter the Church Parish, City and State
	Race is an optional field, If you wish to comment please do so, otherwise it is not required.
	Phone numbers and email addresses will only be used by the office, never for distribution. If you have more than one (1) per field you can enter it, separated by a comma. If a number is an unlisted number, please add a comma and the word unlisted. If your number is not a (985) area code please include the area code in the form.
	Accurate and complete data will help us maintain accurate records of our parishioners. This information will be kept confidential. Please complete all fields that are applicable.
	The SPAM verification code located at the bottom of the page is very important to prevent us from receiving unwanted SPAM messages, if it is not entered correctly in the required form field, your form submission will not be sent. Please enter the code before you submit the form.
	When your form has been successfully submitted you will be redirected to a "thank you" page and you will recieve an email summary (for your records) sent to the "Head of Household" email address, if one was entered.

General Family Information

Family Surname:

Mailiing Address:

City:

State:

Zip Code:

Street Address (if different than above):

City:

State:

Zip Code:

Home Telephone:

Head of Household

Title:

First Name:

Middle Name:

Last Name:

Marital Status:

Marriage Valid in Church:

Marriage Location:

Marriage Date:

Race:

Date of Birth:

Place of Birth:

E-Mail Address:

Cell Phone:

Work Phone:

Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Spouse

Title:

First name:

Middle Name:

Last Name:

Race:

Date of Birth:

E-Mail Address:

Cell Phone:

Work Phone:

Spouse Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Child 1 (Living at Home)

First Name:

Middle Name:

Last Name:

Date of Birth:

Current School:

Grade:

Gender:

Child 1 Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Child 2 (Living at Home)

First Name:

Middle Name:

Last Name:

Date of Birth:

Current School:

Grade:

Gender:

Child 2 Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Child 3 (Living at Home)

First Name:

Middle Name:

Last Name:

Date of Birth:

Current School:

Grade:

Gender:

Child 3 Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Child 4 (Living at Home)

First Name:

Middle Name:

Last Name:

Date of Birth:

Current School:

Grade:

Gender:

Child 4 Sacraments Completed:

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Child 5 (Living at Home)

First Name:

Middle Name:

Last Name:

Date of Birth:

Current School:

Grade:

Gender:

Child 5 Sacraments Completed

Baptism:

Baptism Location:

Baptism Date:

1st Communion:

1st Communion Location:

1st Communion Date:

Confirmation:

Confirmation Location:

Confirmation Date:

Comments or Suggestions:

If you would like the office to contact you directly for your census information, please request here.

Verification Code:

Please insert the verification code to prevent SPAM.

If you do not insert the verification code your form will not be submitted.

Verification Code:

Verification code: