&lt;div&gt; Become part of our church family &lt;/div&gt;

This registration form is intended to let us know a little more about you and your family/household. The more information you can provide the better we can serve and welcome you within our community. If you don't have all of the information, that's ok since you can always update your records through the office.

Head of Household

Date REQUIRED Please fill out this field. Please enter a date.
Family Last Name REQUIRED Please fill out this field. Please enter valid data.
Parent Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Parent Name Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
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.
Marital Status REQUIRED Please fill out this field.

Tithing method desired REQUIRED Please fill out this field.

May we include all provided information in the church directory? REQUIRED Please fill out this field.

May we publish photos of you and your family on social media accounts and any publications? REQUIRED Please fill out this field.

Are you a Valparaiso University student? REQUIRED Yes No Please fill out this field.

In case of emergency, please contact: (List name and number) Please enter valid data.

Why did you choose St. Teresa of Avila Catholic Student Center? REQUIRED Please fill out this field.

Total number of family members REQUIRED Please fill out this field.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.

Check out our Ministries Opportunities at St. Teresa of Avila