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  • Parish Information 
  • What Parish are you registered with and will you celebrate your sacraments in? REQUIRED St.Mary's (Tillsonburg) Sacred Heart (Langton) St. Michael's (Walsh) Please fill out this field.
  • SECTION ONE
    Information about the Child 
  • First Name REQUIRED Please fill out this field. Please enter valid data.
  • Middle Name REQUIRED Please fill out this field. Please enter valid data.
  • Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Sex: REQUIRED (Select One) Male Female Please fill out this field.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  • SECTION TWO
    Information about the Parents 
  • Mother - Last Name/ First Name/Middle Name REQUIRED Please fill out this field. Please enter valid data.
  • Maiden Name Please enter valid data.
  • Religion of Mother REQUIRED Please fill out this field. Please enter valid data.
  • Father - Last Name/ First Name/Middle Name REQUIRED Please fill out this field. Please enter valid data.
  • Religion of Father REQUIRED Please fill out this field. Please enter valid data.
  • SECTION THREE
    Information Regarding Marriage and Family
  • Are you Married REQUIRED Yes No Please fill out this field.
  • Name of Church of Marriage (If not married in the Church, Name of place you were married) Please enter valid data.
  • Date of Marriage Please enter a date.
  • Number of Children Please enter valid data.
  • Ages of Other Children Please enter valid data.
  • Mailing Address ( please include 911#, Unit#, and Postal Code) REQUIRED Please fill out this field. Please enter valid data.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Daytime Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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