We have provided you with the option of a printable
registration/re-registration form that you
can print off and fill out or an online email form can be found
below.
If you choose to fill out the printable form, once completed
please feel free to drop it off at the parish office or at the
registration table which will be available in the gym after all masses. If you
choose to fill out the online email form the information you
provide will be emailed directly to the parish office.
Adobe
Reader is required to view the printable registration form. If you do
not have the appropriate software please click on the link
above.
PARISH REGISTRATION
Please complete this registration if you consider Immaculate
Conception, Port Clinton,
your home parish during all or part of the year.
Children or Dependents Living at Home
(First Child/Dependent)
Name
(First)
(Middle)
(Last)
Relationship to head of household (son,
daughter, etc.)
Gender (check one)
Male
Female
Date of Birth
Place of Birth
(mm/dd/yy)
(City & State)
Sacramental Information Check all that apply
Baptized
Catholic
Reconciliation
First
Eucharist Confirmation
(Second
Child/Dependent)
Name
(First)
(Middle)
(Last)
Relationship to head of household (son,
daughter, etc.)
Gender (check one)
Male
Female
Date of Birth
Place of Birth
(mm/dd/yy)
City & State)
Sacramental Information Check all that apply
Baptized
Catholic
Reconciliation
First
Eucharist Confirmation
(Third
Child/Dependent)
Name
(First) (Middle) (Last)
Relationship to head of household (son,
daughter, etc.)
Gender (check one)
Male
Female
Date of Birth
Place of Birth
(mm/dd/yy)
(City & State)
Sacramental Information Check all that apply
Baptized
Catholic
Reconciliation
First
Eucharist Confirmation
(Fourth
Child/Dependent)
Name
(First)
(Middle)
(Last)
Relationship to head of household (son,
daughter, etc.)
Gender (check one)
Male
Female
Date of Birth
Place of Birth
(mm/dd/yy)
(City & State)
Sacramental Information Check all that apply
Baptized
Catholic
Reconciliation
First
Eucharist Confirmation
(Fifth Child/Dependent)
Name
(First)
(Middle)
(Last)
Relationship to head of household (son,
daughter, etc.)
Gender (check one)
Male
Female
Date of Birth
Place of Birth
(mm/dd/yy)
(City & State)
Sacramental Information Check all that apply
Baptized
Catholic
Reconciliation
First
Eucharist Confirmation
If you need to add additional
children/dependents please submit your original form and fill out a
new form.
Thank you!
414
Madison Street Port Clinton,
Ohio 43452
419.734-4004 iccc@cros.net