St. Richard Parish Registration Form

Instructions

We'd love to meet you in person to register you as a new member of our parish community, but we know it's not
always convenient to stop by the rectory office to do so. So we've created this online registration form for your
convenience. The information requested below is based upon the information that we keep on file for each household.
We ask that you complete all of the fields that pertain to your household. When finished click "Submit." If you have
completed all of the required fields you will then return to the St. Richard Home Page. If you have left required
fields empty you will be prompted to complete the missing information wherepuon you can resubmit your information
when finished. You should receive your weekly contribution envelopes in approximately 4 - 6 weeks. If you have not
received them at the end of this time, please contact the rectory at 215-468-4777. Temporary contribution envelopes
are available at the rectory located at 3010 S. 18th St. Thanks for registering! We'll see you in Church!

Please Note

  • This form requires that javascript be enabled on your web browser. This feature is enabled on web browsers by default. If you manually disabled javascript you must enable it again for the form to display properly and to submit the form.
  • There is a known issue with the MSN Explorer web browser. Those using this web browser will not be able to successfully submit the form because the browser does not properly display the year fields for date of birth. If you use this web browser, please switch to an alternate browser such as Firefox, Internet Explorer, Opera, etc. to submit the form.
  • If problems persist you can download a printable version of our registration form here, which can be completed and returned to the rectory in person or via mail at St. Richard Rectory, 3010 S. 18th Street, Philadelphia, PA 19145.
MAILING INFORMATION:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
CONTACT INFORMATION:
Home Phone:
Alternate Phone 1: Cell: Office: Other:
Alternate Phone 2: Cell: Office: Other:
Email:
Would you like to receive occasional emails regarding happenings and events at the parish?     YesNo
HOUSEHOLD DETAILS:
Head of Household:
Last Name:
Maiden:
First Name:
Date of Birth: / /
Gender:
Occupation:
Ethnicity:
Religion:
Marital Status:
Date of Marriage: / /
Baptized:
Confirmation:
Holy Communion:
Spouse:
Last Name:
Maiden:
First Name:
Date of Birth: / /
Gender:
Occupation:
Ethnicity:
Religion:
Baptized:
Confirmation:
Holy Communion:
Child 1:
Last Name:
First Name:
Date of Birth: / /
Gender:
Ethnicity:
School:
Religion:
Baptized:
Confirmation:
Holy Communion:
Child 2:
Last Name:
First Name:
Date of Birth: / /
Gender:
Ethnicity:
School:
Religion:
Baptized:
Confirmation:
Holy Communion:
Child 3:
Last Name:
First Name:
Date of Birth: / /
Gender:
Ethnicity:
School:
Religion:
Baptized:
Confirmation:
Holy Communion:
Additional Household Members:
Member 1:
Last Name:
First Name:
Relation to Head of Household:
Date of Birth: / /
Gender:
Occupation:
Ethnicity:
School:
Religion:
Baptized:
Confirmation:
Holy Communion:
Member 2:
Last Name:
First Name:
Relation to Head of Household:
Date of Birth: / /
Gender:
Occupation:
Ethnicity:
School:
Religion:
Baptized:
Confirmation:
Holy Communion: