RCIA Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name or Nickname Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Birth Date REQUIRED Please fill out this field. Please enter a date.

Has this attendee been Baptized? REQUIRED Yes No Please fill out this field.

Has this attendee made their first confession? REQUIRED Yes No Please fill out this field.

Has this attendee had their 1st Holy Communion? REQUIRED Yes No Please fill out this field.

Does this attendee have special needs? Please explain below:

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Marital Status of attendee REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Street Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Photo/Video: I grant permission to Queen of Heaven to use images of my family. Such use includes the display, distributions, publications, transmissions or otherwise use of photographs, images and/or videos taken for use in materials that include, but may not be limited to, printed materials such as Brochures, Newsletters, Videos and digital images used on Queen of Heaven Website and Social Media Pages, such as Facebook and for Fundraising Events.

Permission for the use of photos to be used is: REQUIRED Granted Denied Please fill out this field.

	Queen of Heaven Catholic Church Albuquerque, NM Address 5311 Phoenix Avenue NE Albuquerque, NM 87110		Contact Office- 505-881-1772 Fax-505-883-5222 Email Address Email: [email protected]