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REGISTRATION FORM

New to the area or just visiting? We would love to welcome you to our church. Join us for a Mass, learn more about our parish and register with our church. Fill out the form below and submit to let us know about you and your family and your Catholic Faith.

Contact Us

First Person

First Person

First Name:

Last Name

Relation

Birth Date MM/DD/YYYY

Email:

Phone:

Mailing Address , City, State, ZIP

Would you like Offering Envelopes

Yes

No

Catholic?

Yes

No

Married? Marital Status

Yes

No

N/A

Married in a Church?

Yes

No

N/A

Sacramensts Received

Baptism

1st Communion

Confession

Confirmation

Not Sure

None

Second Person

Second Person

First Name

Last Name

Relation

Birth date MM/DD/YYYY

Catholic?

Yes

No

Married? Marital Status

Yes

No

N/A

Married in Church

Yes

No

N/A

Sacraments Received

Baptism

1st Communion

Confession

Not Sure

None

Additional People

Name, Relation, Birthdate, etc

Thank you for contacting us.
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Address 517 W 10th Street, Medford, OR 97501

Office Hours Tuesday - Friday, 9:30am - 4:00pm

Lunch 1:00pm - 2:00pm

Phone 541-779-4661 • Fax 541-774-9474

517 W 10th Street, Medford, OR 97501

Monday - Friday, 9:00am - 1:00pm

P 541-779-4661 • F 541-774-9474

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REGISTRATION FORM﻿

Contact Us

REGISTRATION FORM