OCIA Registration form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Name you go by REQUIRED Please fill out this field. Please enter valid data.

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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Birthdate REQUIRED Please fill out this field. Please enter a date.

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

Have you been baptized? REQUIRED Yes No Please fill out this field.

If yes, what Church were you baptized? REQUIRED Please fill out this field. Please enter valid data.

Date of Baptism REQUIRED Please fill out this field. Please enter a date.

Father's Full Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.

I am... REQUIRED Please fill out this field.

Marital Status REQUIRED Please fill out this field.

If married, is this your first marriage? REQUIRED Yes No Please fill out this field.

Is your spouse Catholic? REQUIRED Yes No Please fill out this field.

If yes, is marriage recognized by Catholic Church? REQUIRED Yes No Please fill out this field.

Spouse's Name REQUIRED Please fill out this field. Please enter valid data.

If engaged, is future spouse Catholic? REQUIRED Yes No Please fill out this field.

Has future spouse been married before? REQUIRED Yes No Please fill out this field.