Registry Information for the Sacrament of Eucharist

							                                  Christ Our Redeemer Catholic Church
                                  1028 White Point Road – Niceville, Florida 32578
                                     (850) 897-7797 ~ FAX: (850) 897-2422
                                             Registry Information
                                                          for the
                                          Sacrament of Eucharist
                     PLEASE PRINT: COMPLETE ALL the information requested (numbers 1-10)
                 the way you want it to appear on your child’s certificate and in our sacramental registry.

1. Family’s LAST NAME: _____________________________2. PHONE NUMBER: _______________

3. CHILD’S NAME: FIRST Name: _______________________________________________________

                      MIDDLE Name: ________________________________________________________
                Baptismal Name (if different from above names): ______________________________________

                        LAST Name: ________________________________________________________

4. PLACE of BIRTH: CITY –________________________________________________________________

                        STATE & COUNTRY – __________________________________________________

5. DATE of BIRTH: (D/M/Y):______________________________________________________________


6a.  Was Your Child Baptized at Christ Our Redeemer? If (YES), please CHECK HERE  
   If NO is your reply, answer 6b and please ATTACH a copy of your child’s Original Baptismal Certificate.
6b.  PLACE of BAPTISM: CHURCH NAME – _____________________________________________

                         CITY – ______________________________________________________________

                         STATE & COUNTRY – _________________________________________________

7. DATE of BAPTISM:             (D/M/Y) :___________________________________________



8. PRESENT Street ADDRESS: ___________________________________________________________

9. CITY & STATE: _______________________________________________________________________

8/9b. Mailing Address (if different from above): ________________________________________________

10. PARENTS:
      FATHER’S FIRST & LAST Name: _____________________________________________________

                MOTHER’S FIRST Name: _____________________________________________________

                MOTHER’S MAIDEN Name:____________________________________________________


                          For OFFICE Use ONLY ~ {Updated: 27 June 06}
DATE of FIRST EUCHARIST: ________________   DATE of FIRST RECONCILIATION: _____________
Recorded & Number in Registry: __________________ Certificate w/Seal: _____________      Notification Sent: _____________
       Computer Entry: ________________________________                 Bulletin Announcement: _______________