SMA Parish: OCIC Child/Teen Inquirer Form

Contact Information and Religious History

Information on this form is held in confidence and is not shared without your permission. We will respond to your application within 7 days. Thank you for your interest!

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* 1. Please provide the following information:

Today's Date

Child/Teen's First Name

Child/Teen's Middle Name

Child/Teen's Last Name

Child/Teen's Maiden Name (if applicable)

Date of Birth

Age

Place of Birth (include LOCALITY [town, city, county, etc.], REGION [state, territory, etc.], COUNTRY.

Grade Level

School

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* 2. List below the name(s) of parent(s)/guardian(s) and present religious afﬁliation, if any:

Parent/Guardian 1 Full Name

Parent/Guardian 1 Relationship

Parent/Guardian 1 Religious Affiliation

Parent/Guardian 2 Full Name

Parent/Guardian 2 Relationship

Parent/Guardian 2 Religious Affiliation

Full Mailing Address

Phone (Day/Evening)

Phone (Cell)

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* 3. Best time to call via phone

Daytime

Evening

Weekend

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* 4. Child/Teen Lives With

Parents

Mother Only

Father Only

Other (please explain)

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* 5. If child/teen lives with one parent/guardian, please indicate who has legal custody and/or if the child/teen also lives with a step-parent:

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* 6. If there is a joint custody arrangement, please provide alternate full address:

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* 7. What, if any, is your religious affiliation?

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* 8. Have your child/teen ever been baptized?

Yes

Not sure

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* 9. If your child/teen received Baptism, include the name of the church, city and state and year received:

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* 10. In what denomination did your child/teen receive baptism?

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* 11. What was your child/teen's approximate age when baptized?

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* 12. What was your child/teen's baptismal name (if different from current name)?

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* 13. Place of Baptism

Name of church/denomination

Address, if known

Location, if known (LOCALITY, REGION, COUNTRY)

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* 14. If you were baptized as a Catholic, check those sacraments you have already received:

Penance (Confession)

Eucharist (First Communion)

Confirmation

20% of survey complete.