Parish Registration Form

First Name

Surname

Email:

Phone Number

Date of Birth :

Place of Birth :

House Name :

Profession

Free Text

Spouse :

First Name(If single, mark SINGLE):

Surname

Place of Birth

House Name :

Profession

Free Text

Child 1:

Name :

Date of Birth :

Place of Birth :

Free Text

Child 2 :

Name :

Date of Birth :

Place of Birth :

Free Text

Child 3 :

Name :

Date of Birth :

Place of Birth :

Free Text

Child 4 :

Name :

Date of Birth :

Place of Birth :

Free Text

Child: 5

Name :

Date of birth

Place of Birth

Free Text

Child 6 :

Name :

Date of Birth :

Place of Birth:

Address :

Suburb :

Postcode

Free Text

Family Unit (Kudumbakoottayma):

Family Unit:

Free Text

Parish Registration Code Number ( Enter the Contribution Number assigned to your family. If none yet - please enter N/A)

New Field:

Free Text

Monthly Pledge Status ( Pledged / Would like to make Monthly Pledge - if yes please enter the amount below)

New Field:

Free Text

Kerala/India Location details ( Please specify where you/your family are originally from)

New Field:

Free Text

Diocese ( Please specify the Diocese you/your family are originally from)

New Field:

Free Text

Extra details ( Additional email address, mobile number, comments etc)

New Field:

By completing this form, I consent to The St. Thomas the Apostle Syro Malabar Forane Church, Brisbane South using the provided information responsibly and maintaining confidentiality in accordance with the Eparchy Privacy Policy. (https://syromalabar.org.au/privacy-policy)

I certify that the information provided in this application form is true to the best of my knowledge and belief and that no information relating to this enrolment application has been omitted

I agree and authorise St. Thomas the Apostle Syro Malabar Forane Church, Brisbane South to keep the above information

I agree for my family members and I to be photographed for Parish Bulletins/ magazines or official website of the parish.

Confirmed by( for internal use only)