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Catholic Parish of Wairarapa
A Warm Welcome
Parish Enrolment Form
Main Contact Details
Persons name
*
First name
Last name
Gender
*
Male
Female
Date of Birth
Persons address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Home phone
Cell phone
*
Email address
*
Marital Status
de Facto
Married
Single
Widow
Are registering or updating details for your partner?
Yes
No
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Your Partner's Details
Persons name
First name
Last name
Gender
*
Male
Female
Date of Birth
Cell phone
Email address
+ Add another
Form Page Break #2
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Next
Registration of Children
Are you registering or updating details for your child or children?
Yes
No
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Next
Your Children
Child Details
Child's Full Name
First name
Last name
Gender
*
Male
Female
Date of Birth
*
+ Add another
- Remove
Form Page Break #4
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Next
Newsletter sign up and optional donation
Would you like to receive our Parish Newsletter?
A donation would be gratefully appreciated
Donation
$5.00
$10.00
$20.00
$50.00
Other amount
$
$5.00
$10.00
$20.00
$50.00
Other
$
Pay/Donate method
Gifting Donation
Make deposit to account
Please make an electronic Bank Transfer using the below details:
Pay to: Parish of the Wairarapa
Bank Account: 02-0688-0049100-00
Reference: Use your First/Last Name
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Submit
Please check the highlighted fields
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