Adult OCIA Form

Current Parish Affiliation:

Registered at St Anthony of Padua St. Leo Student Other

Registering for:

Catechumen Candidate Catholic Candidate Don't Know

Applicants Full Name

Maiden Name (if applicable)

Current Address

City

State

Zip Code

Main Cell Phone Number

Alternate Phone Number

Email Address

Date of Birth

Place of Birth

Fathers Full Name

Mothers Full Name

Mothers Maiden Name

If currently married, Married in Catholic Church

Yes No

Name & Place of Church where Married

Current Spouses Full Name

Spouses Religious Denomination

If Divorced

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

Number of Times Married

Have you been baptized?

Yes No Don't Know

If Baptized, denomination

Fulll Name & Address of Church where Baptized

Have you been Confirmed?

Yes No

Full Name & Denomination of Church where Confirmed

Have you ever received Communion?

Yes No

Full Name and Denomination of Church where received Communion

If annulled by Church provided Protocol # and Date of Decree

Signature

Your Email

How did you learn about our program?

St. Anthony of Padua Catholic Church