Maria Immacolata Church

“Act justly, love tenderly, and walk humbly with God”

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Census/Registration
Head of Household Information

Parish Census - Head of Household Information

(Note: After successfully submitting this form, click here to go to step three, "Spouse" Information or click here to go to step four, "Dependent" Information.)

Census Type:: NewUpdate
Head of Household Name (First / Middle / Last):
Nickname:
Maiden Name (if applicable):
Active Parishioner?: YesNo
Gender:: MaleFemale
Date of Birth:
E-mail Address:
Religion:
Work Phone Number:
Cell Phone Number:
Other Phone Number:
Special Needs (allergies, handicaps, etc.):
First Language:
Ethnicity:
Education Level:
Occupation / Employer or School Name:
Participated in RCIA?: YesNo
Baptized?: YesNo
Baptism Date:
Confirmed?: YesNo
Confirmation Date:
First Reconcilliation (Confession)?: YesNo
First Reconcilliation Date:
First Eucharist (Communion)?: YesNo
First Eucharist Date:

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Home
About Us
Calendar
Bulletins
Sacraments
Ministries
Minister Schedules
Knights
Religious Education
Youth Group
Photos
Online Giving
Mass Intentions
HT Diocese
Safe Environment
RCIA
News
Census/Registration
Contact Us
Supporters
Videos

Maria Immacolata Church
246 Corporate Drive Houma, LA 70360
P: 985-876-3313 | F: 985-879-2137

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