St. Anthony de Padua

Catholic Parish

Est. 1948 | South Bend, Indiana

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Online Registration

- New Parishioners

Please note that you cannot save your registration form part-way through. If you have any issues, please call Tina Masterson in the Parish Office at 574-282-2308.
The maximum number of form submissions has been reached. This form is currently not available.
- Family Information
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family Email Please enter an email address.
  
  Home Phone REQUIRED Please fill out this field. Please enter a phone number.
  
  Emergency Phone REQUIRED Please fill out this field. Please enter a phone number.
- Address Information
  
  Mailing Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  Address 2 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.
  
  Contact Preferences Publish Phone Publish Address Publish Email Receive Visits Receive Contribution Envelopes
- Number of family members you are registering today REQUIRED Please fill out this field.
  
  FAMILY MEMBER 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  FAMILY MEMBER 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nick Name (preferred name) Please enter valid data.
  
  Family Role(s) Husband Father Wife Mother Daughter Son Other
  
  Gender Male Female
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Email Please enter an email address.
  
  Cell Phone Please enter a phone number.
  
  Work Phone Please enter a phone number.
  
  Birth Place Please enter valid data.
  
  Ethnicity Please enter valid data.
  
  First Language REQUIRED Please fill out this field.
  
  Special Needs Please enter valid data.
  
  High School Graduation Year Please enter valid data.
  
  SACRAMENT INFORMATION
  
  Catholic Yes No
  
  Baptism Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Reconciliation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  First Eucharist Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Confirmation Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
  
  Catholic Marriage Yes
  
  Date Please enter valid data.
  
  Location Please enter valid data.
Submit