New Parishioner Registration

Parish Registration

"*" indicates required fields

Parish*

Divine Mercy, Bellevue, KY

St. Bernard, Dayton, KY

Welcome to Divine Mercy Parish!

We warmly welcome new members and are delighted to have you register!

The online registration process is new so please be patient and call us if there are any glitches!

If we haven’t already met, I look forward to meeting you and would ask you to introduce yourself after Mass or to call for an appointment so I can get to know you.

We very much want you to feel at home and a part of our parish family! So we can get to know you better, we will ask you to list the members of your household as a part or your registration process.

You can pause and continue your registration later by clicking “save and continue later,” at the end of the form. Please let me know if you have any questions or if there is anything you need.

Thank You for your time and attention to this registration! It will help us to serve you better.

Sincerely Yours in Christ,

Fr. Martin Pitstick, pastor
(859) 261-6172
pitstickm@gmail.com

Welcome to St. Bernard Church!

We warmly welcome new members and are delighted to have you register!

The online registration process is new so please be patient and call us if there are any glitches!

If we haven’t already met, I look forward to meeting you and would ask you to introduce yourself after Mass or to call for an appointment so I can get to know you.

We very much want you to feel at home and a part of our parish family! So we can get to know you better, we will ask you to list the members of your household as a part or your registration process.

You can pause and continue your registration later by clicking “save and continue later,” at the end of the form. Thank You for your time and attention to this registration! It will help us to serve you better.

Please let me know if you have any questions or if there is anything you need. My office is located in Bellevue (at our sister parish, Divine Mercy).

Sincerely Yours in Christ,

Fr. Martin Pitstick, pastor
(859) 261-6172
pitstickm@gmail.com

Date of Registration*

Head of Household

Head of Household Name*

Prefix First Middle Last Suffix

Gender*

Male

Female

What is your maiden name?*

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

My primary phone is a*

Mobile Phone

Home Land Line

Work Phone

Other

This phone number will be listed in our parish phone directory unless you choose to keep it unlisted.

Yes, please list this number in the parish phone directory

No, I do not want this number listed in the parish phone directory

Do you have second phone number where you can be reached?*

Yes

mobile, land line, work…

Second Phone

My second phone is a

Mobile Phone

Home Land Line

Work Phone

Other

Do you want your secondary phone listed in our parish phone directory?

Yes, please list this number in the parish phone directory

No, please keep it unlisted

Is there a third phone number you might want us to have?

Yes

Third Phone

My third phone is a

Mobile Phone

Home Land Line

Work Phone

Other

Do you want your third phone number listed in our parish phone directory?

Yes, please list in the parish phone directory

No, please keep it unlisted

Do you use e-mail?*

Yes

No, I don’t have/use e-mail

Primary Email*

What is your Date of Birth*

Religion*

Catholic

Non Catholic Christian (Baptist, Anglican, Lutheran, Evangelical, nondenominational…)

Non Christian (Jewish, Muslim, Hindu…)

None or Other

What denomination (if any) would you most identify with?

What is your current religion or religious background?

Please describe any religious background you may have

What is your experience of the Catholic religion?

Are you baptized?*

Yes

I don’t know

What is the name of the church where you were baptized?

What is the city and state of the church where you were baptized?

Date of Baptism

If you don't know the exact date of your baptism can you give us the approximate year?

Are you married? Please choose the best answer.*

I have never been married and am not in a relationship

I have never been married but am currently in a relationship.

I am engaged to be married

I am married

I am married but separated from my spouse

I am divorced and have not remarried

I am widowed and have not remarried

I have previously been married and am presently in a relationship with someone else.

Optional additional information about your marital status?

Does your significant other live with you?*

Yes

Do you have a Catholic Marriage?*

Yes, I was married in the Catholic Church

Uncertain what this means

Date of your Marriage

In what city and state where you were married?

What is the name of the church where you were you married? (Or, if not in a church, what was the location?)*

Who officiated at your marriage?

Have you been married to anyone else previously?

Yes

Previous Marriage(s)

How many times have you been married before?

Once

Twice

Three times

Four or more times

What is the name of the first person you were married to?

What is the name of the second person your were married to?

What is the name of the third person your were married to?

What is the name of the fourth person your were married to?

Spouse's Information

Name of Spouse*

Prefix First Middle Last Suffix

Gender of Spouse*

Male

Female

What is your wife's maiden name?

Birth Date of Spouse*

Does your spouse have a separate phone number?

Yes

Spouse's Phone

Is your spouse's phone a

Mobile Phone?

Home (Land Line)?

Work Phone?

Other

Do you want your spouse's phone number to be listed in our parish directory?

Yes

No, please do not list it in the parish directory

Spouse's E-mail

What is your spouse's religion?*

Catholic

Non Catholic Christian

Non Christian

None or Other

May we ask which denomination (if any) your spouse most identifies with?

May we ask your spouse's current religion or religious background?

Even though your spouse is not Catholic, we welcome them to be a part of our parish family

Please list our household with both of our names as active members (as is normally done)

Please list both of our names even though my spouse will not be active in the parish

Please only list my name on the mailing list and parish directory.

Is your spouse baptized?*

Yes

I don’t know

What is the name of the church where your spouse was baptized?

What is the city and state of the church where your spouse was baptized?

Date of Baptism

Has your spouse been confirmed?*

Yes

Not sure

Is there any other information we should know about your spouse?

Congratulations on your engagement! May the Lord bless and protect you both during this time of preparation!

Fiance(e)'s Information

To whom are you engaged?

Prefix First Middle Last Suffix

Gender of Fiance(e)*

Male

Female

What is your fiance(e)'s maiden name?

Birth Date of Fiance(e)*

Does your fiance(e) have a separate phone number?

Yes

Fiance(e)'s Phone

Is your fiance(e)'s phone a

Mobile Phone?

Home (Land Line)?

Work Phone?

Other

Fiance(e)'s E-mail

What is your fiance(e)'s religion

Catholic

Non Catholic Christian

Non Christian

None or Other

May we ask which denomination (if any) your fiance(e) most identifies with?

May we ask your fiance(e)'s current religion or religious background?

Are you currently living with your Fiance(e)?*

Yes

Is your fiance(e) baptized?*

Yes

I don’t know

Where was your fiance(e) baptized?

What is the city and state of the church where your fiance(e) was baptized?

Date of Fiance(e)'s Baptism

Has your fiance(e) been confirmed?*

Yes

Not sure

Is there anything else we should know about your fiance(e)?

Significant Other's Information

Name of Significant Other*

Prefix First Last Suffix

Gender of Significant Other*

Male

Female

What is your significant other's maiden name?

Birth Date of Significant Other*

Does your significant other have a separate phone number?

Yes

Significant Other's Phone

Is your significant other's phone a

Mobile Phone?

Home (Land Line)?

Work Phone?

Other

Significant Other's E-mail

What is your significant other's religion?*

Catholic

Non Catholic Christian

Non Christian

None Other

May we ask which denomination (if any) your significant other most identifies with?

May we ask your significant other's current religion or religious background?

Is your significant other baptized?*

Yes

I don’t know

Where was your significant other baptized?

What is the city and state of the church where your significant other was baptized?

Date of Significant Other's Baptism

Has your significant other been confirmed?*

Yes

Not sure

Has your significant other ever been married?

Yes

I don’t know

How many times has your significant other been married?

once

I am not sure, but at least once

more than once

Is there anything else we should know about your significant other?

Children and other Household Members

Please be sure to list all children and related adults living in your household.

Do you have any children or other adults living in your household?*

Yes

Are there any children under the age of 14?*

Yes

Please record other members of your household: children under your care, parents, grandparents or other related adults. (You do not need to list unrelated adults with whom you are sharing rent, but it would be helpful to mention them in the final comments.)

1

Name*

First Middle Last Suffix

Birth Date*

Gender*

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?*

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

Continue with another member?

Yes

That was the last one

2

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

Continue with another?

Yes

That was the last one

3

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

Continue?

Yes

That was the last one

4

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

More?

Yes

That was the last one

5

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

Continue?

Yes

That was the last one

6

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

Next?

Yes

That was the last one

7

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

One more?

Yes

That was the last one

8

Name

First Middle Last Suffix

Birth Date

Gender

Male

Female

Relationship

City of birth?

Name of Father

First Middle Last Suffix

Name of Mother

First Middle Last Suffix

Mother's maiden name?

Baptized?

Unbaptized

Baptized Catholic

Baptized in another Christian denomination

What is the name of the church where they were baptized?

What is the city and state of the church where they were baptized?

You indicated that either you or a member of your household is either not baptized or not Catholic. Would you like information about getting baptized or becoming Catholic?

I would like information about having a child baptized

I would like information about adult baptism, the Catholic Faith, or or becoming Catholic

I would like to set up a meeting with Father

Other

For information about Baptism or Becoming Catholic, go to: https://dmsbcatholic.com/catholic-faith/

You indicated that you were not married in the Catholic Church, are living with someone, or that you are uncertain about your marital status. Would you like information about how to have a valid Catholic marriage?

Yes, I would like information about how to have my marriage be valid in the Catholic Church

I would like information about getting married in the Catholic Church

I have other questions and would like to set up a time to meet with Father

Other

Catholics should be aware that they may not receive Holy Communion if they are in an invalid marriage or living together outside of marriage.

You mentioned that there younger children in your household. Would you like information about our Catholic school or Parish Religious Education Program (PREP)?

Yes

Here is our school’s website: https://www.holytrinity-school.org/ Here is information on our Parish Religious Education Program (PREP): https://dmsbcatholic.com/ccd/

May we ask what led you to register, and is there anything else you would like us to know?

Name

This field is for validation purposes and should be left unchanged.