Parish Registration

- Register / Report a Change

This form is not accepting responses at this time.
- To become a registered member of our parish family, please complete the digital form below OR click on the printable link to download our form to complete and mail it in to us.
- Today's/Registration Date: REQUIRED Please fill out this field. Please enter a date.
- FAMILY DETAILS
- MAILING ADDRESS DETAILS
  
  Family's Full Mailing Name: REQUIRED Maximum 35 characters
  The formal mailing name to address all parish mailings to.
  Please fill out this field. Please enter valid data.
  
  Mailing 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.
  
  Primary Phone: REQUIRED Maximum 20 characters
  12
  Please fill out this field. Please enter a phone number.
  
  Phone is: REQUIRED Cell Home Please fill out this field.
  
  Primary Family Email: REQUIRED Maximum 35 characters Please fill out this field. Please enter an email address.
- Previously registered? REQUIRED
  On your own or as a child under parents.
  No Yes Please fill out this field.
- If yes, last name registered under AND what years? Please enter valid data.
- Are there any special needs we should be aware of? Please enter valid data.
- FAMILY MEMBER DETAILS
  Complete for each individual in your home, including yourself.
- Total number of family members being registered: REQUIRED Please fill out this field.
  
  Family Member 1
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 2
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 3
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 4
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 5
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 6
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 7
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 8
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 9
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
  
  Family Member 10
  
  Role: REQUIRED Head of Household Spouse Daughter Son Partner Stepchild Parent Grandparent Other individual living in the home Please fill out this field.
  
  Gender: REQUIRED Please fill out this field.
  
  Title: Maximum 4 characters Please enter valid data.
  
  First Name: REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
  
  Middle Initial: Maximum 2 characters Please enter valid data.
  
  Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name: Please enter valid data.
  
  Birthdate:
  Providing this date help us with demographic reporting.
  Please enter a date.
  
  Marital Status: REQUIRED Please fill out this field.
  
  Date of Marriage, REQUIRED if married: Please enter a date.
  
  Language: REQUIRED Please fill out this field.
  
  Birthplace: Maximum 35 characters Please enter valid data.
  
  Religion: REQUIRED Please fill out this field.
  
  Ethnicity: REQUIRED Please fill out this field.
  
  Email, if different from primary email: Please enter an email address.
  
  Occupation: Please enter valid data.
  
  Sacraments received in the Catholic Church:
  Please check all that apply.
  Baptism First Penance/Reconciliation First Holy Communion Confirmation Sacrament of Marriage (received during mass.)
- .
  
  ONLINE GIVING OPTION
  Would you like to enroll in online offering, doing away with remembering your offertory envelopes each Sunday? By enrolling in recurring donations, be it weekly or monthly, it is easy. To enroll now, please click the WeShare image to the left, or enroll at a later time by way of the link within our parish website.
  
  OUR PARISH MINISTRIES
  Please review the ministries our parish offers for you and possibly your family to become involved in. If you're interested, please click on the link to your left for details on how to join them. New members are always a very welcome addition to any of our ministries.
  lAdult Choir lAltar Servers (4th graders and up) lFaith Formation Catechist lChildrens Choir lEucharistic Minister lHoly Name Society lLector lSt. Joseph's Guild/Altar Society lUsher lYouth Ministry (6th to 8th graders) lYoung Woman's Bible Study Group (ages 18 to 28)
  
  PARISH COMMUNICATION OPTION
  Blessed Sacrament looks forward to keeping in touch with you from time to time about parish updates and events, etc. If you would like to stay connected, click the Flocknote image to the left to enroll now to ensure you won't miss out on any parish news.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blessed Sacrament Church

30 Manor Road, Staten Island, NY 10310

Parish Registration

OUR PARISH MINISTRIES

lAdult Choir lAltar Servers (4th graders and up) lFaith Formation Catechist lChildrens Choir lEucharistic Minister lHoly Name Society lLector lSt. Joseph's Guild/Altar Society lUsher lYouth Ministry (6th to 8th graders) lYoung Woman's Bible Study Group (ages 18 to 28)