Join our Pastorate

REGISTRATION

Register our family at the following location (choose one):

Portage St. Mary of the Immaculate Conception

Montello St. John the Baptist, Montello

Pardeeville & Buffalo St. Faustina, Pardeeville & Buffalo

Briggsville St. Mary Help of Christians, Briggsville

Westfield Good Shepherd, Westfield

Family Last Name 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. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter valid data.

Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.

Previous Parish (Church name and location) Please enter valid data.

Would you like to receive the Catholic Herald Newspaper? ($12.00 for 6 months subscription) REQUIRED Yes (mail or drop off payment to the Parish Office) No Please fill out this field.

Would you like to receive Giving Envelopes mailed directly to your home or do you prefer to give online? REQUIRED Mail envelopes to my home Give online Please fill out this field.

Household Members (please include all family members)

Head of Household

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

Email REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

Date of Birth (01/01/1901) REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Marital Status REQUIRED Please fill out this field.

Sacraments Received Baptism Reconciliation First Eucharist Confirmation Matrimony Holy Orders

Date each Sacrament was received (if known) Please enter valid data.

Church of Baptism (name, city, state) Please enter valid data.

Religion (if not Catholic) Please enter valid data.

Date each Sacrament was received (if known) Please enter valid data.

Church of Baptism (name, city, state) Please enter valid data.

Religion (if not Catholic) Please enter valid data.