Register "*" indicates required fields Parish* Divine Mercy, Bellevue, KY St. Bernard, Dayton, KY Welcome 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* MM slash DD slash YYYY Head of HouseholdHead of Household Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Gender* Male Female What is your maiden name?*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*My primary phone is a* Mobile Phone Home Land Line Work Phone Other This 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 directory No, I do not want this number listed in the parish phone directory Do you have second phone number where you can be reached?* Yes No mobile, land line, work...Second PhoneMy second phone is a Mobile Phone Home Land Line Work Phone Other Do you want your secondary phone listed in our parish phone directory? Yes, please list this number in the parish phone directory No, please keep it unlisted Is there a third phone number you might want us to have? Yes No Third PhoneMy third phone is a Mobile Phone Home Land Line Work Phone Other Do you want your third phone number listed in our parish phone directory? Yes, please list in the parish phone directory No, please keep it unlisted Do you use e-mail?* Yes No, I don't have/use e-mail Primary Email* What is your Date of Birth* MM slash DD slash YYYY Religion* Catholic Non Catholic Christian (Baptist, Anglican, Lutheran, Evangelical, nondenominational...) Non Christian (Jewish, Muslim, Hindu...) None or Other What 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?* Yes No I don't know What 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 MM slash DD slash YYYY If you don't know the exact date of your baptism can you give us the approximate year?Are you married? Please choose the best answer.* I have never been married and am not in a relationship I have never been married but am currently in a relationship. I am engaged to be married I am married I am married but separated from my spouse I am divorced and have not remarried I am widowed and have not remarried I have previously been married and am presently in a relationship with someone else. Optional additional information about your marital status?Does your significant other live with you?* Yes No Do you have a Catholic Marriage?* Yes, I was married in the Catholic Church No Uncertain what this means Date of your Marriage 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? Yes No Previous Marriage(s)How many times have you been married before? Once Twice Three times Four or more times What 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* Male Female What is your wife's maiden name?Birth Date of Spouse* MM slash DD slash YYYY Does your spouse have a separate phone number? Yes No Spouse's PhoneIs your spouse's phone a Mobile Phone? Home (Land Line)? Work Phone? Other Do you want your spouse's phone number to be listed in our parish directory? Yes No, please do not list it in the parish directory Spouse's E-mail What is your spouse's religion?* Catholic Non Catholic Christian Non Christian None or Other May 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 family Please 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 parish Please only list my name on the mailing list and parish directory. Is your spouse baptized?* Yes No I don't know What 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 MM slash DD slash YYYY Has your spouse been confirmed?* Yes No Not sure Is 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)* Male Female What is your fiance(e)'s maiden name?Birth Date of Fiance(e)* MM slash DD slash YYYY Does your fiance(e) have a separate phone number? Yes No Fiance(e)'s PhoneIs your fiance(e)'s phone a Mobile Phone? Home (Land Line)? Work Phone? Other Fiance(e)'s E-mail What is your fiance(e)'s religion Catholic Non Catholic Christian Non Christian None or Other May 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)?* Yes No Is your fiance(e) baptized?* Yes No I don't know Where 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 MM slash DD slash YYYY Has your fiance(e) been confirmed?* Yes No Not sure Is 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* Male Female What is your significant other's maiden name?Birth Date of Significant Other* MM slash DD slash YYYY Does your significant other have a separate phone number? Yes No Significant Other's PhoneIs your significant other's phone a Mobile Phone? Home (Land Line)? Work Phone? Other Significant Other's E-mail What is your significant other's religion?* Catholic Non Catholic Christian Non Christian None Other May 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?* Yes No I don't know Where 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 MM slash DD slash YYYY Has your significant other been confirmed?* Yes No Not sure Has your significant other ever been married? Yes No I don't know How many times has your significant other been married? once I am not sure, but at least once more than once Is there anything else we should know about your significant other?Children and other Household MembersPlease be sure to list all children and related adults living in your household.Do you have any children or other adults living in your household?* Yes No Are there any children under the age of 14?* Yes No Please record other members of your household: children under your care, parents, grandparents or other related adults. (You do not need to list unrelated adults with whom you are sharing rent, but it would be helpful to mention them in the final comments.)1Name* First Middle Last Suffix Birth Date* MM slash DD slash YYYY Gender* Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized?* Unbaptized Baptized Catholic Baptized in another Christian denomination What 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? Yes That was the last one 2Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What 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? Yes That was the last one 3Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue? Yes That was the last one 4Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What is the name of the church where they were baptized?What is the city and state of the church where they were baptized?More? Yes That was the last one 5Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Continue? Yes That was the last one 6Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What is the name of the church where they were baptized?What is the city and state of the church where they were baptized?Next? Yes That was the last one 7Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What 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? Yes That was the last one 8Name First Middle Last Suffix Birth Date MM slash DD slash YYYY Gender Male Female Relationship son daughter grandchild brother sister Other City of birth?Name of Father First Middle Last Suffix Name of Mother First Middle Last Suffix Mother's maiden name?Baptized? Unbaptized Baptized Catholic Baptized in another Christian denomination What 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 baptized I would like information about adult baptism, the Catholic Faith, or or becoming Catholic I would like to set up a meeting with Father Other For information about Baptism or Becoming Catholic, go to: https://dmsbcatholic.com/catholic-faith/You indicated that you were not married in the Catholic Church, are living with someone, or that you are uncertain about your marital status. 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 Church I would like information about getting married in the Catholic Church I have other questions and would like to set up a time to meet with Father Other Catholics should be aware that they 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)? Yes No Here is our school's website: https://www.holytrinity-school.org/ Here is information on our Parish Religious Education Program (PREP): https://dmsbcatholic.com/ccd/May we ask what led you to register, and is there anything else you would like us to know?PhoneThis field is for validation purposes and should be left unchanged.
