Register Parish*Divine Mercy, Bellevue, KYSt. Bernard, Dayton, KYWelcome to Divine Mercy Parish! We warmly welcome new members and are delighted to have you register! The online registration process is new so please be patient and call us if there are any glitches! If we haven't already met, I look forward to meeting you and would ask you to introduce yourself after Mass or to call for an appointment so I can get to know you. We very much want you to feel at home and a part of our parish family! So we can get to know you better, we will ask you to list the members of your household as a part or your registration process. You can pause and continue your registration later by clicking "save and continue later," at the end of the form. Please let me know if you have any questions or if there is anything you need. Thank You for your time and attention to this registration! It will help us to serve you better. Sincerely Yours in Christ, Fr. Martin Pitstick, pastor (859) 261-6172 pitstickm@gmail.comWelcome to St. Bernard Church! We warmly welcome new members and are delighted to have you register! The online registration process is new so please be patient and call us if there are any glitches! If we haven't already met, I look forward to meeting you and would ask you to introduce yourself after Mass or to call for an appointment so I can get to know you. We very much want you to feel at home and a part of our parish family! So we can get to know you better, we will ask you to list the members of your household as a part or your registration process. You can pause and continue your registration later by clicking "save and continue later," at the end of the form. Thank You for your time and attention to this registration! It will help us to serve you better. Please let me know if you have any questions or if there is anything you need. My office is located in Bellevue (at our sister parish, Divine Mercy). Sincerely Yours in Christ, Fr. Martin Pitstick, pastor (859) 261-6172 pitstickm@gmail.comDate of Registration* Date Format: MM slash DD slash YYYY Head of HouseholdHead of Household Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Gender*MaleFemaleWhat is your maiden name?*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*My primary phone is a*Mobile PhoneHome Land LineWork PhoneThis phone number will be listed in our parish phone directory unless you choose to keep it unlisted.Yes, please list this number in the parish phone directoryNo, I do not want this number listed in the parish phone directoryDo you have second phone number where you can be reached?*YesNomobile, land line, work...Second PhoneMy second phone is aMobile PhoneHome Land LineWork PhoneDo you want your secondary phone listed in our parish phone directory?Yes, please list this number in the parish phone directoryNo, please keep it unlistedIs there a third phone number you might want us to have?YesNoThird PhoneMy third phone is aMobile PhoneHome Land LineWork PhoneDo you want your third phone number listed in our parish phone directory?Yes, please list in the parish phone directoryNo, please keep it unlistedDo you use e-mail?*YesNo, I don't have/use e-mailPrimary Email* What is your Date of Birth* Date Format: MM slash DD slash YYYY Religion*CatholicNon Catholic Christian (Baptist, Anglican, Lutheran, Evangelical, nondenominational...)Non Christian (Jewish, Muslim, Hindu...)None or OtherWhat denomination (if any) would you most identify with?What is your current religion or religious background?Please describe any religious background you may haveWhat is your experience of the Catholic religion?Are you baptized?*YesNoI don't knowWhat is the name of the church where you were baptized?What is the city and state of the church where you were baptized?Date of Baptism Date Format: MM slash DD slash YYYY Are you married?*I have never been marriedI am marriedI am engaged to be marriedI am presently in a relationship with someoneI am married but separated from my spouseI am divorced and have not remarriedI am widowed and have not remarriedDoes your significant other live with you?*YesNoDo you have a Catholic Marriage?*Yes, I was married in the Catholic ChurchNoUncertain what this meansDate of your Marriage Date Format: MM slash DD slash YYYY In what city and state where you were married?What is the name of the church where you were you married? (Or, if not in a church, what was the location?)*Who officiated at your marriage?Have you been married to anyone else previously?YesNoPrevious Marriage(s)How many times have you been married before?OnceTwiceThree timesFour or more timesWhat is the name of the first person you were married to?What is the name of the second person your were married to?What is the name of the third person your were married to?What is the name of the fourth person your were married to?Spouse's InformationName of Spouse* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Gender of Spouse*MaleFemaleWhat is your wife's maiden name?Birth Date of Spouse* Date Format: MM slash DD slash YYYY Does your spouse have a separate phone number?YesNoSpouse's PhoneIs your spouse's phone aMobile Phone?Home (Land Line)?Work Phone?Do you want your spouse's phone number to be listed in our parish directory?YesNo, please do not list it in the parish directorySpouse's E-mail What is your spouse's religion?*CatholicNon Catholic ChristianNon ChristianNone or OtherMay we ask which denomination (if any) your spouse most identifies with?May we ask your spouse's current religion or religious background?Even though your spouse is not Catholic, we welcome them to be a part of our parish familyPlease list our household with both of our names as active members (as is normally done)Please list both of our names even though my spouse will not be active in the parishPlease only list my name on the mailing list and parish directory.Is your spouse baptized?*YesNoI don't knowWhat is the name of the church where your spouse was baptized?What is the city and state of the church where your spouse was baptized?Date of Baptism Date Format: MM slash DD slash YYYY Has your spouse been confirmed?*YesNoNot sureIs there any other information we should know about your spouse?Congratulations on your engagement! May the Lord bless and protect you both during this time of preparation!Fiance(e)'s InformationTo whom are you engaged? Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Gender of Fiance(e)*MaleFemaleWhat is your fiance(e)'s maiden name?Birth Date of Fiance(e)* Date Format: MM slash DD slash YYYY Does your fiance(e) have a separate phone number?YesNoFiance(e)'s PhoneIs your fiance(e)'s phone aMobile Phone?Home (Land Line)?Work Phone?Fiance(e)'s E-mail What is your fiance(e)'s religionCatholicNon Catholic ChristianNon ChristianNone or OtherMay we ask which denomination (if any) your fiance(e) most identifies with?May we ask your fiance(e)'s current religion or religious background?Are you currently living with your Fiance(e)?*YesNoIs your fiance(e) baptized?*YesNoI don't knowWhere was your fiance(e) baptized?What is the city and state of the church where your fiance(e) was baptized?Date of Fiance(e)'s Baptism Date Format: MM slash DD slash YYYY Has your fiance(e) been confirmed?*YesNoNot sureIs there anything else we should know about your fiance(e)?Significant Other's InformationName of Significant Other* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Gender of Significant Other*MaleFemaleWhat is your significant other's maiden name?Birth Date of Significant Other* Date Format: MM slash DD slash YYYY Does your significant other have a separate phone number?YesNoSignificant Other's PhoneIs your significant other's phone aMobile Phone?Home (Land Line)?Work Phone?Significant Other's E-mail What is your significant other's religion?*CatholicNon Catholic ChristianNon ChristianNone OtherMay we ask which denomination (if any) your significant other most identifies with?May we ask your significant other's current religion or religious background?Is your significant other baptized?*YesNoI don't knowWhere was your significant other baptized?What is the city and state of the church where your significant other was baptized?Date of Significant Other's Baptism Date Format: MM slash DD slash YYYY Has your significant other been confirmed?*YesNoNot sureIs there anything else we should know about your significant other?Other Household MembersDo you have any children or other adults living in your household?*YesNoAre there any children under the age of 14?*YesNo1Name* First Middle Last Suffix Birth Date* Date Format: MM slash DD slash YYYY Gender*MaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?*UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue with another member?YesThat was the last one2Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue with another?YesThat was the last one3Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue?YesThat was the last one4Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?More?YesThat was the last one5Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue?YesThat was the last one6Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Next?YesThat was the last one7Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?One more?YesThat was the last one8Name First Middle Last Suffix Birth Date Date Format: MM slash DD slash YYYY GenderMaleFemaleRelationshipsondaughterCity of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?UnbaptizedBaptized CatholicBaptized in another Christian denominationWhat is the name of the church where they were baptized?What is the city and state of the church where they were baptized?You indicated that either you or a member of your household is either not baptized or not Catholic. Would you like information about getting baptized or becoming Catholic?I would like information about having a child baptizedI would like information about adult baptism, the Catholic Faith, or or becoming CatholicI would like to set up a meeting with FatherYou indicated that you were not married in the Catholic Church or that you were uncertain about this. Would you like information about how to have a valid Catholic marriage?Yes, I would like information about how to have my marriage be valid in the Catholic ChurchI would like information about getting married in the Catholic ChurchI have other questions and would like to set up a time to meet with FatherCatholics may not receive Holy Communion if they are in an invalid marriage or living together outside of marriage.You mentioned that there younger children in your household. Would you like information about our Catholic school or Parish Religious Education Program (PREP)?YesNoIs there anything else you would like us to know?
