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Parish Census Form

Parish Census Form

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Family Last Name *

Street Address *

City / State / Zip *

Home Phone Number *

Head of Household – Full Name *

First

Middle

Last

Date of Birth *

Email *

Cell Phone Number

Sacraments Received *

Baptism
First Holy Communion
Confirmation
Sacramental Marriage
None

Ministries

Knights of Columbus
Council of Catholic Women
Legion of Mary
Music Ministry
Respect Life Ministry
Parish Disability Ministry
Saint Monica Society
St. Vincent de Paul Society
That Man is You
Wings of Yarn Ministry
Youth Ministry

Talent

Military Service

Veteran
Active Military

Spouse – Full Name

First

Middle

Last

Date of Birth

Email

Cell Phone Number

Sacraments Received

Baptism
First Holy Communion
Confirmation
Sacramental Marriage
None

Ministries

Knights of Columbus
Council of Catholic Women
Legion of Mary
Music Ministry
Respect Life Ministry
Parish Disability Ministry
Saint Monica Society
St. Vincent de Paul Society
That Man is You
Wings of Yarn Ministry
Youth Ministry

Talent

Military Service

Veteran
Active Military

Date of Marriage

Child # 1 – Full Name

First

Middle

Last

Date of Birth

Sacraments Received

Baptism
First Holy Communion
Confirmation
None

Child # 2 – Full Name

First

Middle

Last

Date of Birth

Sacraments Received

Baptism
First Holy Communion
Confirmation
None

Child # 3 – Full Name

First

Middle

Last

Sacraments Received

Baptism
First Holy Communion
Confirmation
None

Date of Birth

Child # 4 – Full Name

First

Middle

Last

– # Additional

Date of Birth

Sacraments Received

Baptism
First Holy Communion
Confirmation
None

Child # 5 – Full Name

First

Middle

Last

Date of Birth

Sacraments Received

Baptism
First Holy Communion
Confirmation
None

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Useful Links

The Diocese of Harrisburg
Diocese of Harrisburg Youth Protection Program
FORMED
Holy Family Radio AM720
Diocese of Harrisburg Cursillo Movement
Holy Name of Jesus School

Contact

6150 Allentown Boulevard
Harrisburg, PA 17112-2603

Phone: 717-652-4211
Fax: 717-652-2033

HolyNameOfJesusParishHarrisburg@hbgdiocese.org

Home
Welcome
Sacraments
Ministries
Events
- Parish Calendar
Programs
- Religious Education Program
- Youth Protection Clearance
Parish Census Form