Register At Saint Bernadette By Completing the Form Below

Family Last 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.

Previous Parish Please enter valid data.

Primary Email to Receive Parish News Please enter valid data.

Primary Phone Number to be listed in Parish Directory REQUIRED Please fill out this field. Please enter valid data.

Head of Household

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Preferred Name Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Religion REQUIRED Please fill out this field.
Marital Status REQUIRED Please fill out this field.
Wedding Anniversary Date Please enter a date.
Phone Number Maximum 20 characters Please enter a phone number.
Email Please enter an email address.
Occupation Please enter valid data.
Employer Please enter valid data.

Spouse

First Name Please enter valid data.

Last Name Please enter valid data.
Preferred Name Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Religion
Phone Number Maximum 20 characters Please enter a phone number.
Cell Phone Please enter valid data.
Email Please enter an email address.
Occupation Please enter valid data.
Employer Please enter valid data.

Child 1

First Name Please enter valid data.

Last Name Please enter valid data.
Preferred Name Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Religion
Does this child need sacraments? None Baptism First Communion Confirmation
Current School and Grade Please enter valid data.
Are you interested in learning more about Saint Mary Academy for this child? Yes No Already Enrolled

Child 2

First Name Please enter valid data.

Last Name Please enter valid data.
Preferred Name Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Religion
Religion
Does this child need sacraments? None Baptism First Communion Confirmation
Current School and Grade Please enter valid data.
Are you interested in learning more about Saint Mary Academy for this child? Yes No Already Enrolled

Child 3

First Name Please enter valid data.

Last Name Please enter valid data.
Preferred Name Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Religion
Religion
Does this child need sacraments? None Baptism First Communion Confirmation
Current School and Grade Please enter valid data.
Are you interested in learning more about Saint Mary Academy for this child? Yes No Already Enrolled

Child 4

First Name Please enter valid data.

Last Name Please enter valid data.
Preferred Name Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Religion
Religion
Does this child need sacraments? None Baptism First Communion Confirmation
Current School and Grade Please enter valid data.
Are you interested in learning more about Saint Mary Academy for this child? Yes No Already Enrolled

Gifts: We welcome you to our parish and would like to know if you have any gifts that you would be willing to share – ministry, medical training, office skills, special talents, etc.

What kind of ministries are you interested in learning more about at Saint Bernadette? Liturgical Ministries (lector, usher, hospitality) Music Ministries Social Outreach Ministries Fellowship Opportunities Adult Faith Formation Opportunities Children's Faith Formation Opportunities Administrative Opportunities

Have you clicked like and follow on our Parish Facebook page? ((find us at https://www.facebook.com/SaintBernadetteLouisville ) Yes No

Have you visited the parish giving page at https://stb2008.weshareonline.org/ and set up a regular contribution? (see flyer below) Yes No I have NOT set up a regular contribution and need further assistance.