RCIA :: Our Lady of Prompt Succor Catholic Church

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Classes begin in the Fall and will be
held each Wednesday
from 6:00 - 7:15 PM in the St. Michael Room.

One form must be submitted per person enrolling in class.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Name as It Appears on Birth Certificate REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Address REQUIRED Maximum 50 characters 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.
Place of Birth REQUIRED Please fill out this field. Please enter valid data.
E-Mail Address REQUIRED Please fill out this field. Please enter valid data.
Home Phone Maximum 50 characters Please enter valid data.
Cell Phone Maximum 50 characters Please enter valid data.
Work Phone Maximum 50 characters Please enter valid data.
Father's Full Birth Name (as shown on birth certificate) REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
Father's Religion Please enter valid data.
Mother's Full Birth Name (as shown on birth certificate) REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
Mother's Religion Please enter valid data.
Have you been baptized? REQUIRED No Yes Please fill out this field.
Date of Baptism Please enter a date.
Church of Baptism Please enter valid data.
Place of Baptism Please enter valid data.
If baptized Catholic, did you make First Holy Communion? No Yes Not Sure
Date of First Communion Please enter a date.
Place of First Communion Please enter valid data.
Place of First Communion Please enter valid data.
Have you participated in another Church? REQUIRED No Yes Please fill out this field.
What prompted you to come to these sessions at this time?
Select one
I definitely want to become a Catholic. I think I might want to become a Catholic. I'm just looking - Not sure at this time. I'm just curious about what Catholics believe. I don't want to join - just want to know more about the Catholic Church.
Please check all that apply: I'm presently engaged. I am presently married. My spouse is Catholic. I am presently separated. I am divorced and remarried. My first spouse is deceased. I am divorced but not remarried. I have never been married in the Catholic Church. I have been married only once. I was married before. I have been divorced more than once. I am a widow/widower.
I have my annulment papers Yes - Complete Not yet - In process No - Never Started Process Does not apply
Other information regarding your marital status:
Name of Spouse Maximum 50 characters
Current spouse
Please enter valid data.
Names of children and their ages
You must choose a sponsor to share in your Faith Journey. They must be a Confirmed Catholic, in good standing, and able to receive Holy Communion. An updated Baptismal Certificate is required from his/her church of baptism.
Is there any Catholic friend that you would like to have as a sponsor*? If yes, list their info below. REQUIRED
*Sponsor - ordinarily someone other than a spouse or family member
Yes No Not Sure Please fill out this field.
First Name Please enter valid data.

Last Name Please enter valid data.
Phone Number Maximum 20 characters
Sponsor's Phone#
Please enter a phone number.
Email
Sponsor's E-mail
Please enter an email address.
Is he/she available to come to our RCIA sessions? Yes No Sometimes
Are you attending Mass regularly? REQUIRED No Yes Please fill out this field.
Why / Why not?
How would you describe your relationship with Jesus?
What is the Lord asking of your today?
How can we be more helpful to you at this time?

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