Adult RCIA Form

Parish Affiliation (select all applicable)

Registered at St Anthony of Padua St. Leo Student Other

Registering for:

Catechumen Candidate Catholic Candidate Don't Know

Applicants Full Name

Applicants Maiden Name (if applicable)

Fathers Full Name

Mothers Full Name

Mothers Maiden Name

Current Spouses Full Name

Current Spouses Religious Denomination

Current Address

City

State

Zip Code

Main Phone Number

Alternate Phone Number

Email Address

Date of Birth

Place of Birth

Have you been baptized?

Yes No Don't Know

If Baptized, denomination

Fulll Name, Address, & Denominaton of Church where Baptized

Have you been Confirmed?

Yes No

Full Name, Address, & denomination of Church where Confirmed

Have you ever received Communion?

Yes No

Full Name, Address, & denomination where received Communion

Current Marital Status

Single Never Married Engaged for 1st Time Married

If checked Married

1st Time Widow/Widower Separated Divorced

If Divorced

Divorced not remarried Divorced and remarried Divorced ad annulled by the church

If Divorced, how many times?

If annulled by Church provided Protocol # and Date of Decree

Signature

How did you learn about our program?

Your Email

St. Anthony of Padua Catholic Church