Order of Christian Initiation (OCIA) Registration First Name Middle Name Last Name Familiar Name Maiden Name Date of Birth Place of Birth Current Address Primary Phone Is this a cell phone or landline? Cell Phone Landline Secondary Phone Is this a cell phone or landline? Cell Phone Landline Email In the event of an emergency or last minute cancellation, how would you prefer to be notified? (Choose all that apply.) Call to primary phone Text to primary phone Call to secondary phone Text to secondary phone Email Previous Church Affiliation Are you baptized? Yes, I was baptized Catholic. Yes, I was baptized in another faith. No, I have not been baptized. I'm not sure. Date of Baptism Place of Baptism Father's Full Name Father's Religion Mother's Full Name (Including Maiden Name) Mother's Religion Your Marital Status Single Engaged Married If you are single: I have never been married. I am divorced. I am a widow(er). If you are married: This is my first marriage. I am divorced and remarried. If divorced and remarred, was your previous marriage annulled? Yes No Name of Spouse/Fiance Spouse/Fiance's Religion Date of Current Marriage Place of Current Marriage Married by: Priest Minister Rabbi Other If you and/or your spouse are Catholic and you were married by someone other than a Catholic priest, has your marriage been "blessed" or validated in the Catholic Church, or did you receive a dispensation? Yes No I'm not sure If yes, date of dispensation or convalidation If yes, place of dispensation or convalidation If yes, name of priest or deacon Do you have children under age 18 living in your household? Yes No Child 1 Has this child been baptized? Yes, baptized Catholic Yes, baptized in another faith No, not baptized Child 2 Has this child been baptized? Yes, baptized Catholic Yes, baptized in another faith No, not baptized Child 3 Has this child been baptized? Yes, baptized Catholic Yes, baptized in another faith No, not baptized Child 4 Has this child been baptized? Yes, baptized Catholic Yes, baptized in another faith No, not baptized Child 5 Has this child been baptized? Yes, baptized Catholic Yes, baptized in another faith No, not baptized Reasons for Coming to OCIA (check all that apply) I definitely want to become Catholic. I am "just looking"; not sure at this time. I do not want to become Catholic; but want to know what Catholics believe. I am a Catholic and want to learn more about the Faith. I have been away from the Church and want to return to the practice of the Faith. My spouse/fiance is Catholic. What or who prompted you to explore Catholicism at this time? Briefly describe your religious background, education, and former ministry involvement. For those baptized in the Catholic Church only: I have received the following sacraments Eucharist (First Communion) Reconciliation (First Confession) Confirmation If you have received First Communion in the Catholic Church, where did you receive the sacrament? When did you receive the sacrament? If you have received First Reconciliation in the Catholic Church, where did you receive the sacrament? When did you receive the sacrament? If you have received Confirmation, where did you receive the sacrament? When did you receive the sacrament? Send
