St Peter - RegistrationMember Home

Parish Registration Form

Welcome to our Church.
Click Submit Form to send this information to St Peter Canisius, International Catholic Parish Jakarta.

"If you register individually, please register as head of household.
If you register as a family/household, you only need to submit one form for the whole family."

Head of Household

Title

First Name *

Middle Name

Last Name *

Nickname

Baptism name
(if any)

Ethnicity

Date of Birth *

Gender *

Nationality *

Country of Origin

Latest Education

Native Language *

Marital Status

Occupation

Phone 1 *

Phone 2

Emergency Phone

Email 1 *

Email 2

Sacraments

Name

Received Date Country City Diocese Church/Parish name

Baptism

First Holy Communion

Confirmation

Matrimony

Current Home Address in Indonesia

Line 1 *

Line 2

City *

Province *

Zip *

Family address in Home Country

Line 1

Line 2

City

State/Province

Zip

Member 1

Title

First Name *

Middle Name

Last Name *

Nickname

Baptism name
(if any)

Relationship *
with the Head of Household

Ethnicity

Date of Birth *

Gender *

Nationality *

Latest education

Native Language *

Marital Status

Country of Origin

Occupation

Phone 1 *

Phone 2

Emergency Phone

Email 1 *

Email 2

Sacraments

Name

Received Date Country City Diocese Church/Parish name

Baptism

First Holy Communion

Confirmation

Matrimony

Click Submit Form to send this information to St Peter Canisius International Catholic Parish Jakarta.

Please ensure all data has been checked thoroughly
If you have any question, please contact our parish office WA +628118039728

Parish Registration Form

Head of Household

Sacraments

Current Home Address in Indonesia

Family address in Home Country

Member 1

Sacraments

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