R.C.I.A. Inquirer Form

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

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

Street Address 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.

Email REQUIRED Please fill out this field. Please enter an email address.

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

Which of the following statements best describes your present feelings and thoughts about joining the Catholic Church: REQUIRED I would like to learn more before I join the Church. I am fairly certain I want to join the Church but need time to study and pray about it. I am certain I want to join the Church. Please fill out this field.

What is your present Religious affiliation? REQUIRED Please fill out this field. Please enter valid data.

Have you ever been baptized? REQUIRED Yes No I am not sure Please fill out this field.

If you answered yes to the previous question, please list the name of the Church and denomination. Please enter valid data.

If baptized Catholic, which sacraments have you received (mark all that apply) Baptism Communion Reconciliation Confirmation