Facebook Twitter Flocknote

Register/ Update Family Information

- About

Our warmest regards to all who join our parish family! Please complete this registration form or update your family information so we can stay connected.
The maximum number of form submissions has been reached. This form is currently not available.
- New or Current Family REQUIRED Please fill out this field.
- Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last 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.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Spouse Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
- Additional Family Members (Children/Parents) REQUIRED Please fill out this field.
  
  Family Member 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 5
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 6
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 7
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 8
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 9
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
  
  Family Member 10
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Currently In Religious Education Program Yes
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Church of St. Anastasia

Harriman, NY

Register/ Update Family Information