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Parish Registration Form

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Welcome to Queen of Peace Parish. Our parish family is so please to welcome you and looks forward to the sharing of your gifts and talents! We pray you make our parish part of your spiritual journey. Please complete the online registration form. You will receive a confirmation of your parish registration. If you have any questions regarding how you can be involved, please don't hesitate to call the Parish Office at 319-226-3655.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (if applicable) REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Gender REQUIRED Male Female Please fill out this field.
- Ethnicity REQUIRED Hispanic/Latino/Spaniard Origin Black/African-American Asian/Pacific Islander White/Other Please fill out this field.
- Primary Language REQUIRED Please fill out this field.
- Faith REQUIRED Please fill out this field.
- * Please Specify REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received - Select all completed REQUIRED Please fill out this field.
- Name of Parish (if applicable) REQUIRED Please fill out this field. Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- *Name of Parish (if applicable) REQUIRED Please fill out this field. Please enter valid data.
- City/State of Marriage REQUIRED Please fill out this field. Please enter valid data.
- Date of Marriage REQUIRED Please fill out this field. Please enter valid data.
- Employment Information REQUIRED Employed Unemployed Retired Full-time Student Please fill out this field.
- Occupation REQUIRED Please fill out this field. Please enter valid data.
- Employer Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Spouse First Name REQUIRED Please fill out this field. Please enter valid data.
- Spouse Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Spouse Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Ethnicity REQUIRED Hispanic/Latino/Spaniard Origin Black/African-American Asian/Pacific Islander White/Other Please fill out this field.
- Primary Language REQUIRED Please fill out this field.
- Faith REQUIRED Please fill out this field.
- * Please Specify REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received - Select all completed REQUIRED Please fill out this field.
- Employment Information REQUIRED Employed Unemployed Retired Full-time Student Please fill out this field.
- Occupation REQUIRED Please fill out this field. Please enter valid data.
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