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Register as a New Member

- I'm New
  - Register as a New Member
  - FORMED
Contact Us
- Keri Gockel
  
  Coordinator of Empowering Christian Action (Communications & Welcoming)
  
  K.Gockeldbqarch.org

Welcome!
As a new member, we welcome your active participation in the life of our community and challenge you to deepen your relationship with God. We invite you to make spiritual growth a priority, and join a ministry or small group to fully experience the belonging we foster here. We have many volunteers who are ready to welcome you into the parish family of St. Columbkille.
How to Register

If you would like to officially register with our parish, please contact us at 563-583-9117, or submit the online form below. A printable version is also available (click here).

Thank you – we look forward to welcoming you into our parish family!
The maximum number of form submissions has been reached. This form is currently not available.
- Please indicate the number of adults and/or children you wish to register, then provide the requested information for each.
- Adults in Household REQUIRED Please fill out this field.
  
  Adult 1
  
  Title/Suffix REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Snowbird Address Please enter valid data.
  
  Preferred Email REQUIRED
  If you don't have email, simply type "N/A"
  Please fill out this field. Please enter valid data.
  
  Preferred Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Do you wish to be contacted by text with parish communications? REQUIRED Yes, please No, thank you Please fill out this field.
  
  Marital Status REQUIRED Please fill out this field.
  
  Wedding Date Please enter valid data.
  
  Wedding Location Please enter valid data.
  
  Married by (if applicable): Priest/Deacon Other
  
  Church Affiliation REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  Previous parish of registration Please enter valid data.
  
  Employer REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Parish Tithing - I wish to engage in financial stewardship via: REQUIRED Contribution envelope Electronic Funds Transfer (EFT) Please fill out this field.
  
  Adult 2
  
  Title/Suffix REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  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.
  
  Snowbird Address Please enter valid data.
  
  Preferred Email REQUIRED
  If you don't have email, simply type "N/A"
  Please fill out this field. Please enter valid data.
  
  Preferred Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Do you wish to be contacted by text with parish communications? REQUIRED Yes, please No, thank you Please fill out this field.
  
  Marital Status REQUIRED Please fill out this field.
  
  Wedding Date Please enter valid data.
  
  Wedding Location Please enter valid data.
  
  Married by (if applicable): Priest/Deacon Other
  
  Church Affiliation REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  Previous parish of registration Please enter valid data.
  
  Employer REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Parish Tithing - I wish to engage in financial stewardship via: REQUIRED Contribution envelope Electronic Funds Transfer (EFT) Please fill out this field.
- Children/Dependents in Household (age 18 and under) REQUIRED Please fill out this field.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 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.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
  
  Child/Dependent 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to you: REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  School Attending (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2021/2022) REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received (check all that apply) REQUIRED Baptism Eucharist Confirmation None Please fill out this field.
  
  Please indicate any disabilities you would like us to be aware of. Please enter valid data.
Submit

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