Request for Key Contact Information

Please list children 12 years of age and younger living in your household and confirm their date of birth.

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth

05/12/2020

Please enter a date.

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth

05/12/2020

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First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth

05/12/2020

Please enter a date.

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth

05/12/2020

Please enter a date.

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth

05/12/2020

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Thirteen years of age and over begin here!

Adult #1

ADULT #1 Last Name REQUIRED Please fill out this field. Please enter valid data.

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

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

goes by Please enter valid data.

Date of Birth

05/12/2020

Please enter a date.

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

Identify Type of Phone REQUIRED Landline Mobile Please fill out this field.

My PRIMARY PHONE may be shared with a parishioner. Yes No

Mobile Phone Please enter a phone number.

My MOBILE PHONE may be shared with a parishioner. Yes No

PRIMARY Email Please enter an email address.

My PRIMARY EMAIL may be shared with a parishioner. REQUIRED Yes No Please fill out this field.

Please list ministries, activities and organizations you participate in at the parish.

Adult #2

ADULT #2 Last Name REQUIRED Please fill out this field. Please enter valid data.

First Name Please enter valid data.

Middle Name Please enter valid data.

goes by Please enter valid data.

Date of Birth

05/12/2020

Please enter a date.

PRIMARY Phone Please enter a phone number.

Identify Type of Phone Landline Mobile

My PRIMARY PHONE may be shared with a parishioner. Yes No

Mobile Phone Please enter a phone number.

My MOBILE PHONE may be shared with a parishioner. Yes No

PRIMARY Email Please enter an email address.

My PRIMARY EMAIL may be shared with a parishioner. Yes No

Please list ministries, activities and organizations you participate in at the parish.

Parish Membership

I am a member of: St. Boniface Parish St. Meinrad Parish St. John Chrysostom Parish (New Boston, IN) Please contact me to learn more about becoming a member of St. Boniface Parish. Please contact me to learn more about becoming a member of St. Meinrad Parish. Other (Please explain below.)

If you selected other, please explain.

Physical Address (E911 Address Verification) 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.

Temporary Address

A student living away at college in on or off campus housing.

Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Mailing Address - If a PO Box complete below. Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

I would like more information about?

I wish to receive information from my parish family.

Did you know each member of our parish family has a unique profile and parishioner number allowing you to stay connected by text or email by merely identifying your personal preferences for receiving each one of the following parish resources, including your copy of the weekly bulletin, invitations, calendar reminders and news alerts.

The primary way I wish to receive information from my parish family:

NEWS ALERTS REQUIRED Email Text Message Weekly Bulletin Received at Mass Please fill out this field.

CALENDAR REMINDERS REQUIRED Email Text Message Weekly Bulletin Received at Mass Please fill out this field.

I wish to receive a regular listing of Petitions and Prayer Requests from the parish prayer chain to pray with throughout the week. Yes

How would you like to receive a weekly listing of Prayer Requests and Petitions from the Prayer Chain? Email Phone Message Text Message Weekly Bulletin Received at Mass

For parishioners age 65 and over, since Governor Holcomb's March 24th "stay at home" order now to a "remain at home whenever possible" please answer the following questions:

Since the CDC's Guidance for Faith-Based Organizations and Houses of Worship regarding the Coronavirus Disease 2019 (COVID-19) inhibits in person worship, have you found a resource for Sunday Mass on local television or radio? Yes No

Does your home have Internet access? Yes No

If you do not have Internet access at home, please identify your alternate method for accessing the internet. No. We cannot access the internet. Yes. A family member has an internet enabled devise provided by the school corporation. Yes. Access at a local restaurant or business establishment Yes. Access at the local library Yes. Borrow an internet enabled device from a family member or friend. Yes. Access at a friend or family member’s home. Other (Please explain below.)

If you selected other, please explain.

Please once again confirm your PRIMARY EMAIL below:

PRIMARY EMAIL REQUIRED Please fill out this field. Please enter an email address.

Thank you for your patience.

Request for Key Contact Information

MEMO

How do you want to receive information?

Please list children 12 years of age and younger living in your household and confirm their date of birth.

Thirteen years of age and over begin here!

Parish Membership

For parishioners age 65 and over, since Governor Holcomb's March 24th "stay at home" order now to a "remain at home whenever possible" please answer the following questions:

Please once again confirm your PRIMARY EMAIL below: