RCIA Intake Form

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
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.
Place of Birth (City, State, Country) REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Current Age REQUIRED Please fill out this field. Please enter valid data.
Mailing 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.
Occupation REQUIRED Please fill out this field. Please enter valid data.
What, if any, is your present religious affiliation? REQUIRED Please fill out this field. Please enter valid data.
Have you ever been baptized? REQUIRED Yes No Unsure Please fill out this field.
If you were baptized Catholic, please select ALL Sacraments below that you have already recevied: Penance (Reconciliation/Confession) Eucharist (First Holy Communion) Confirmation
Currnet Marital Status: (Please select ALL that apply) REQUIRED Never Married Engaged to be Married Married, but separated from my spouse Divorced and have not remarried Widow/Widower and I have not remarried Please fill out this field.
SECTION FOR CANDIDATE WHO IS ENGAGED TO BE MARRIED
If you are engaged, you MUST complete this section!
Fiance's Full Name REQUIRED Please fill out this field. Please enter valid data.
Fiance's current religious affiliation REQUIRED Please fill out this field. Please enter valid data.
Please select the appropriate choice for YOURSELF (not your Fiance) This is my first marriage I have been married before
Please select the appropriate choice for your Fiance: This is his/her first marriage He/She has been married before
SECTION FOR CANDIDATE WHO IS MARRIED
If you are married, you MUST complete this section!
Spouse's Full Name Please enter valid data.
Spouse's current religious affiliation (if any) Please enter valid data.
Please select the appropriate choice for YOURSELF (not your Spouse) This is my first marriage I have been married before
Please select the appropriate choice for your Spouse: This is his/her first marriage He/She has been married before
Date of Marriage REQUIRED Please fill out this field. Please enter a date.
Place of Marriage (City, State, Country) Please enter valid data.
Who was the officiating authority of your marriage? Civil Government Non-Christian Minister Christian Minister Catholic Clergy Other
MAC Pastorate consists of 3 Parishes - Which Parish would you like to call home? REQUIRED Please fill out this field.
Please provide any additional information that you believe may be important for our RCIA team to know.
Email REQUIRED Please fill out this field. Please enter an email address.

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RCIA Intake Form

SECTION FOR CANDIDATE WHO IS ENGAGED TO BE MARRIED

SECTION FOR CANDIDATE WHO IS MARRIED