Rite of Christian Initiation for Adults (RCIA) Registration Form

Contact Information

1. Last Name REQUIRED Please fill out this field. Please enter valid data.
2. Given Names (first and middle names) REQUIRED Please fill out this field. Please enter valid data.
3. Gender Male Female Prefer not to say
4. Full Mailing Address (Street, City, Province, Postal Code) REQUIRED Please fill out this field.
5. Email REQUIRED Please fill out this field. Please enter an email address.
6. Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Personal Information

7. Birth Date REQUIRED Please fill out this field. Please enter a date.
8. Place of Birth (City, Province/State, Country) Please enter valid data.
9. Father's Name (First, Middle, Last) Please enter valid data.
10. Mother's Name (First, Middle, Last) Please enter valid data.
11. Mother's Maiden Name Please enter valid data.
12. Father's Religion Please enter valid data.
13. Mother's Religion Please enter valid data.
14. a) Do you have any children you would like to prepare for the Christian Initiation (baptism)? Yes No
14. b) If yes, please list the children's names and ages

What Best Describes Your Reason for Being Here

15. What has led you to consider the RCIA at this point? REQUIRED I definitely want to become Catholic I am not sure at this time if I want to become Catholic, but I want to learn more I do not wish to become Catholic, but I do want to better understand what Catholics believe I am Catholic, but need First Eucharist and Confirmation I am Catholic, but need Confirmation I am Catholic, and I would like to learn more about our faith Please fill out this field.

Baptismal Information: Please note if you have been baptized, you will be asked to provide a copy of your baptismal certificate when the RCIA program begins.

16. a) Have you been baptized? REQUIRED Yes No Not Sure Please fill out this field.
If you have been baptized, please fill in the next four questions.
16. b) If you have been baptized, when was the date of your baptism? Please enter a date.
16. c) If you have been baptized, what was the denomination of the church? Please enter valid data.
16. d) If you have been baptized, what was the name of the church where you were baptized? Please enter valid data.
16. e) If you have been baptized, what is the address of the Church where you were baptized? (Please include the street, city, province, postal code, country)

Marital Status: These questions help us to understand whether you may need an annulment. Even if you are not sure if you want to become Catholic, we encourage you to speak with a priest or an RCIA team member if you think you may need an annulment.

17. What is your marital status? REQUIRED Single Engaged Married Common-law Married, but separated Widowed Divorced, not remarried Divorced, remarried Please fill out this field.

OPTIONAL: Please answer the following six questions if you are currently engaged.

18. a) If you are engaged, what is the name of your fiancé(e)? Please enter valid data.
18. b) What is your fiancé(e)'s religion? Please enter valid data.
18. c) Is this your first marriage? Yes No
18. d) Is this your fiancé(e)'s first marriage? Yes No
18. e) Do you plan to be married in the Catholic church? Yes No
18. f) If yes, what is the name of the parish and priest you have consulted? Please enter valid data.

OPTIONAL: Please answer the following five questions if you are currently common-law.

19. a) If you are in a common-law relationship, what is the name of your partner? Please enter valid data.
19. b) Have you been married before? Yes No
19. c) If yes, number of previous marriages? Please enter valid data.
19. d) Has your partner been married before? Yes No
19. e) If yes, number of previous marriages? Please enter valid data.

OPTIONAL: Please answer the following four questions if you are currently married.

20. a) If you are married, what is the name of your spouse? Please enter valid data.
20. b) Is your spouse Catholic? Yes No
20. c) Were you married in a Catholic ceremony? Yes No
20. d) Have either you or your spouse been previously married? Yes No

OPTIONAL: If you are now married, and either you or your spouse has been divorced, please complete the following questions.

21. How many marriages have you had previous to this one? Please enter valid data.
22. How many marriages has your spouse had previous to this one? Please enter valid data.
23. Have you applied for an annulment from the Catholic Church? Yes No

Mary, Mother of the Church

A Roman Catholic Parish in the Archdiocese of St. Boniface in Winnipeg

Rite of Christian Initiation for Adults (RCIA) Registration Form