AT THIS TIME, REGISTRATION CANNOT BE SUBMITTED ONLINE.   

Please print  form and mail or fax it to us at:

The Holy Family Church
28 Brookline Avenue
Nutley, New Jersey  07710
Fax#  973-661-1714

ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL.

Full Name:  _________________________________________________________________________

Street Address:  _____________________________________________________________________

City:                      _____________________________________________________________________

State:                   ____________________________Zip Code:   ________________________________

Home Telephone:        _______________________Work Telephone:____________________________

Occupation:_______________________________Spouse's Occupation:________________________

Email Address:   ____________________________________________________________________

GSA Family ?:_______________________________________________________________________

Name of those living at  this address: ___________________________________________________

________________________________________________________________________________

How Related? _____________________________________________________________________

Birthday: __________________________________________________________________________

Country of Birth :____________________________________________________________________

Confirmed? _______________________________________________________________________

If husband and wife listed above were married in a Catholic Church, please put the date of the wedding:

   ________________________________________________________________________________

Nationality:  ________________________________________________________________________

If anyone listed above is not Catholic, please list their name and religious affiliation: ________________

Full Name:   _______________________________________________________________________

Religious Affiliation:   ________________________________________________________________

Would you like one of our priests to call you?   Select              YES                       NO

If anyone above is homebound, please list the name(s) below with comma after each name: ________

________________________________________________________________________________
 

Would you like donation envelopes mailed to you or will you be using Parish Pay?:__________________

_________________________________________________________________________________