Welcome to Saint Rose of Lima Catholic Church
 Parishioner Registration Form
 Bienvenido a nuestra hoja de Registracion

Click Submit Form to send this information to Saint Rose of Lima.

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*Required fields

*Registration Option Register a New Family Update an Existing Family *ID/Env:  
  Call Saint Rose of Lima at (407) 932-5004, if you do not know your ID Number or Envelope Number.
Head of Household
Title *First Name *Last Name
Relationship Maiden Name
Ethnicity   Birth Date *Gender Female   Male
  Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Email 1   Unlisted
Sacraments   Name Received Date
   Baptism
   Confirm
   First Comm
   Marriage
Spouse
Title   First Name   Last Name
Relationship Maiden Name
Ethnicity   Birth Date   Gender Female   Male
  Language Marital Status
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Sacraments   Name Received Date
   Baptism
   Confirm
   First Comm
   Marriage
Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP
Family Mailing Address
  Line 1
  Line 2
  City
  State
  ZIP
Family Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Email
*Email   Unlisted
Send Email Instead of Mail When Possible
Member 1   Type  
  First Name   Last Name
Relationship   Middle Name
Ethnicity   Birth Date   Gender Female   Male
Grade/Degree   Language
Sacraments   Name Received Date
   Baptism
   Confirm
   First Comm

Click Submit Form to send this information to Saint Rose of Lima.

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