Parish census / registration form Parish Census Data (2) "*" indicates required fields Family Last Name*Local Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a permanent resident at Bethany Beach?* Yes No Other Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Which is your primary address?* Mailing Other Local home phone number Husband’s Cell Phone number Wife’s Cell Phone numberEmail for family contact Send Email Instead of Mail When Possible?* Yes No Marital Status* Single Married Widow(er) Separated Divorced Wife's Maiden Name*Couple Married by* Priest Deacon Other Number of Children Living at Home*Please enter a number greater than or equal to 0.Family InformationOnly list children living at home. If more than three, please list information in the Additional Information Textbox below. If a child’s last name is different than the family name, please list the last name.Head of HouseholdName*Personal PhonePersonal Email Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Faith Background* Catholic Non-Catholic If Catholic:* Catholic Baptized First Communion Penance Confirmation None If non-Catholic, current non-Catholic denomination (or enter N/A)Occupation*(Previous, If Retired)School Attending (if Student)*Put ‘N/A’ if you’re not a studentLanguageOther than English spoken at homeSex* Male Female Race*SpouseName*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Faith Background* Catholic Non-Catholic If Catholic:*Please Check All That Apply. Baptized Catholic First Communion Penance Confirmation None If non-Catholic, current non-Catholic denomination (or enter N/A)Occupation*(Previous, If Retired)School Attending (if Student)*Put ‘N/A’ if you’re not a studentLanguageOther than English spoken at homeSex* Male Female Race*Child-1Name*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Faith Background* Catholic Non-Catholic If Catholic:*Please Check All That Apply. Baptized Catholic First Communion Penance Confirmation None If non-Catholic, current non-Catholic denomination (or enter N/A)Occupation*(Previous, If Retired)School Attending (if Student)*Put ‘N/A’ if you’re not a studentLanguageOther than English spoken at homeSex* Male Female Race*Child-2Name*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Faith Background* Catholic Non-Catholic If Catholic:*Please Check All That Apply. Baptized Catholic First Communion Penance Confirmation None If non-Catholic, current non-Catholic denomination (or enter N/A)Occupation*(Previous, If Retired)School Attending (if Student)*Put ‘N/A’ if you’re not a studentLanguageOther than English spoken at homeSex* Male Female Race*Child-3Name*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Faith Background* Catholic Non-Catholic If Catholic:*Please Check All That Apply. Baptized Catholic First Communion Penance Confirmation None If non-Catholic, current non-Catholic denomination (or enter N/A)Occupation*(Previous, If Retired)School Attending (if Student)*Put ‘N/A’ if you’re not a studentLanguageOther than English spoken at homeSex* Male Female Race*Additional InformationName | DOB | Baptized | Catholic | First Communion | Penance | Confirmation | Occupation | School Attending | Language | Sex | RaceIf more space is needed for additional family members, please list answers to the questions as they appear in the section above.Parish Financial SupportPlease indicate your preferred method of contributing to the parish. Note that you will NOT be mailed monthly contribution envelopes unless you select that preference below. Also, online giving is always possible, even if it is not your preferred method.Thank you!* Online giving Church envelopes Other Parish ActivitiesIf you or anyone else listed on this form are interested in sharing your time by participating in a parish activity, please cut and paste the link below into your browser. Please fill out one form for each person who is volunteering If multiple members of your family wish to volunteer, it’s best to fill out one form for each person. Click here to open a ministry volunteer form DisabilitiesDisabilitiesList Name of Family Member and List Type of Disability (Hearing Impaired, Physically Handicapped, Mentally Handicapped, Blind, Other)DirectionsDirections*Plese list directions to your Bethany area home to assist the Pastor in reaching your home in an emergency. Please list directions in the space below from St. Ann’s to your home.PhoneEmail UntitledUntitled First Choice Second Choice Third Choice PhoneThis field is for validation purposes and should be left unchanged.
