Family Registration Form

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Click Submit Form to send this information to Our Lady of Mercy.

*Required fields

*Family Option	New Family Information	Update Existing Family Information ID/Env:
	Call Our Lady of Mercy at (954) 421-3246, if you do not know your ID Number or Envelope Number.

Head of Household
Title		Suffix
*First Name		*Last Name

Relationship		Maiden Name
		Birth Date
*Gender
		Marital Status

Spouse
Title		Suffix
First Name		Last Name
		Nickname
		Maiden Name
Ethnicity		Birth Date
Gender		Grade/Degree
Language		Marital Status

Family Street Address
*Line 1
Line 2
*City
*State
*ZIP

Family Mailing Address
Line 1
Line 2
City
State
ZIP

Family Phone Numbers
*Primary		( ) - Unlisted
Other		( ) - Unlisted
Email
*Email		Unlisted
		Send Email Instead of Mail When Possible

Click Submit Form to send this information to Our Lady of Mercy.

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Our Lady of Mercy