Helping bring the Hillsboro community to Christ through Prayer, Sacrament, and Charity

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- St. Rose of Lima Catholic Church Registration Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Type of Registration REQUIRED
  Are you registering for the first time, or did you want to change how we register you?
  New Registration Change of Registration Please fill out this field.
  
  Where should we send a confirmation Email (if desired)?
  If you want to recieve a confirmation email, please include it here.
  Please enter an email address.
  
  Contact Information
  
  Family Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address Line 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Address Line 2 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.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parish History
  
  Previous Parish Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Please tell us about your family:
  
  Member
  
  First Name (please include maiden name) REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Church Where Baptised Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Church Where Confirmed Please enter valid data.
  
  Occupation and Company Name REQUIRED Please fill out this field. Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Mobile Phone Number Maximum 20 characters Please enter a phone number.
  
  Marriage and Children
  
  Marital Status REQUIRED Single Married Widowed Separated Divorced Please fill out this field.
  
  Where were you married? Please enter valid data.
  
  Date of Marriage Please enter a date.
  
  Number of Children REQUIRED Please fill out this field.
  
  For families with more than three children, please include any additional children's names, gender, date and place of birth, school attending, grade attending, Baptismal year and church, First Eucharist year and church, and Confirmation year and church in the More Information box at the end of this form.
  
  Spouse
  
  First Name (please include maiden name) Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptism Yes No
  
  Church Where Baptised Please enter valid data.
  
  Confirmation Yes No
  
  Church Where Confirmed Please enter valid data.
  
  Occupation and Company Name Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Mobile Phone Number Maximum 20 characters Please enter a phone number.
  
  First Child
  
  Child's First Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter a date.
  
  Place of Birth Please enter valid data.
  
  State
  
  School Attending Please enter valid data.
  
  Grade
  
  Baptism Year
  
  Baptism Church Please enter valid data.
  
  First Eucharist Year
  
  First Eucharist Church Please enter valid data.
  
  Confirmation Year
  
  Confirmation Church Please enter valid data.
  
  Second Child
  
  First Name Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Child's First Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter a date.
  
  Place of Birth Please enter valid data.
  
  State
  
  School Attending Please enter valid data.
  
  Grade
  
  Baptism Year
  
  Year Baptised Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  Baptism Church Please enter valid data.
  
  First Eucharist Year
  
  Year of First Eucharist Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  First Eucharist Church Please enter valid data.
  
  Confirmation Year
  
  Year Confirmed Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  Confirmation Church Please enter valid data.
  
  Third Child
  
  First Name Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Child's First Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter a date.
  
  Place of Birth Please enter valid data.
  
  State
  
  School Attending Please enter valid data.
  
  Grade
  
  Baptism Year
  
  Year Baptised Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  Baptism Church Please enter valid data.
  
  First Eucharist Year
  
  Year of First Eucharist Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  First Eucharist Church Please enter valid data.
  
  Confirmation Year
  
  Year Confirmed Maximum 4 characters Please enter an integer (number) from 0 to 4.
  
  Confirmation Church Please enter valid data.
  
  More information
  
  Submit
  
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- Please join us!
  
  If you wish to join St. Rose, please take a moment to complete our registration form on this page.