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- Welcome!
  
  If you are new to our parish, or if you never registered, please fill out the Registration Form below or call the parish office to let the office know who you are!
  217-345-3332
Parish registration form
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Family Information
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Adult Members in the Household REQUIRED Please fill out this field.
  
  Adult 1
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Adult 2
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Adult 3
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Adult 4
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Adult 5
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Adult 6
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Marital Status
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Marriage Date Please enter a date.
  
  Marriage Location Please enter valid data.
  
  Children REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 3
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 4
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 5
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 6
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 7
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 8
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 9
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Child 10
  
  First Name Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Religion Please enter valid data.
  
  Race Please enter valid data.
  
  School Please enter valid data.
  
  Grade Please enter valid data.
  
  Birth Date Please enter a date.
  
  Sacraments Received Baptism 1st Communion Confirmation
  
  Comments/Remarks/Interests
  
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St. Charles Borromeo Catholic church

Charleston, IL

Welcome!

Parish registration form