Holy Name Parish - Pembroke Ontario

Declaration of Nullity (Annulment)

Parish Registration

To register as a parishioner of Holy Name Parish, you can fill out the form below and click the Send button. Your information will be sent by e-mail to the parish office. Or pick up a registration form at the back of the church, and place it in the collection basket during mass, or return it to the office during business hours.

Fields marked with * are required. Use the <tab> key to move to the next field or <shift|tab> to move to the previous field.

Once you submit the form, it will check for missing information and remind you to fill in the missing fields. You will receive a copy of the message sent to the parish office, so you can check it over, and keep it for your records.

Please check all that apply	New Parishioner
	New to Pembroke
	Have attended Holy Name for some time and would now like to register.
	I am registering myself.
	I am registering my family.
	I would like a box of donation envelopes.
Parish Member:	I joined Holy Name parish
* Family Name:
* First Name:
Spouse's Name:
* Street Address:
* Town:
* Postal Code:

Phone Numbers:	* home:
Person 1 Name:	bus:
Person 2 Name:	bus:
* Family e-mail address:
Children First & Last Names and Dates of Birth:

We respect your privacy. All your personal information is held confidentially.

Please enter any question or comments below:


Most Holy Name of Jesus
	Roman Catholic Church
	Parish Priest: Father Steven F. Ballard, J.C.L.

Bayberry Lane Designs