New Parishioner Registration

To St. Pius X
- Welcome to the family!
  
  If you are ready to enroll as a member of St. Pius X Catholic Church, please fill out the form on this page. Our Administrative Assistant will contact you after receiving your form to find out your schedule a visit with our Pastor.
  
  Not quite sure or still investigating? That's okay! If you'd like to talk with someone before deciding, see below to contact Calli at the parish office.
Contact Me for help!
- Calli Eickhoff
  
  Financial Assistant/Accounts Payable
  
  317-466-3352
  ceickhoffspxparish.org
LET'S GET STARTED JOINING THE PARISH
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Please List the Family Name
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family Address
  
  Home 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.
  
  Family Email REQUIRED Please fill out this field. Please enter an email address.
  
  Family Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Male/Female Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Initial Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthday REQUIRED Please fill out this field. Please enter a date.
  
  Religion (Please Check one) REQUIRED Catholic Non-Denominational Methodist Lutheran Baptist Jewish Presbyterian Episcopal Other Please fill out this field.
  
  Sacraments Received
  
  Please check appropriate box/es Baptism Holy Eucharist (First Communion) Confirmation Holy Matrimony
  
  Additional Information
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Email 2 Please enter valid data.
  
  Are you a graduate of St. Pius X Catholic School Yes no
  
  If Married
  
  If you are married, are you married in the Catholic Church, either originally or by convalidation (Marriage Blessing)? REQUIRED Yes No Please fill out this field.
  
  Marriage Date (if applicable) Please enter valid data.
  
  Male/Female Head of Household (if applicable)
  
  First Name Please enter valid data.
  
  Middle Initial Please enter valid data.
  
  Maiden Name (if applicable) Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthday Please enter valid data.
  
  Religion (Please Check one) REQUIRED Catholic Non-Denominational Methodist Lutheran Baptist Jewish Presbyterian Episcopal Other Please fill out this field.
  
  Sacraments Received
  
  Please check appropriate box/es Baptism Holy Eucharist (First Communion) Confirmation Holy Matrimony
  
  Marriage Date Please enter valid data.
  
  Additional Information
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Employment Please enter valid data.
  
  Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Email Address REQUIRED Please fill out this field. Please enter valid data.
  
  Are you a graduate of St. Pius X Catholic School? Yes no
  
  Number of Other Family Members Living at Home (Needed Fields Will Appear when greater than 0) Please fill out this field.
  
  Family Member 1
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 2
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 3
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 4
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 5
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 6
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 7
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Family Member 8
  
  Full Name (Include last name if different) Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender (Male/Female) Please enter valid data.
  
  Relation Please enter valid data.
  
  Religion Please enter valid data.
  
  Current Grade Level Please enter valid data.
  
  School Attending (if still in school) Please enter valid data.
  
  Baptised Y/N * Please enter valid data.
  
  Holy Communion Y/N * Please enter valid data.
  
  Confirmation Y/N* Please enter valid data.
  
  Person to Notify in Case of Emergency
  
  Name of Person Please enter valid data.
  
  Cell Phone Please enter valid data.
  
  Work Phone Please enter valid data.
  
  Email Address REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship Please enter valid data.
  
  Additional Information
  
  Is there anything else that you would like us to know about you or your family?
  
  Submit
  
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New Parishioner Registration

Male/Female Head of Household (if applicable)

Person to Notify in Case of Emergency

Additional Information