Parish Registration Form

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Name:

First Name

Surname

Email:

Phone Number

Date of Birth :

Place of Birth :

House Name :

Profession

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Spouse :

First Name(If single, mark SINGLE):

Surname

Phone No

Date of Birth :

Place of Birth :

House Name :

Profession

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Child 1:

Name :

Date of Birth :

Place of Birth :

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Child 2 :

Name :

Date of Birth :

Place of Birth :

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Child 3 :

Name :

Date of Birth :

Place of Birth

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Child 4 :

Name :

Date of Birth :

Place of Birth :

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Child: 5

Name

Date of birth

Place of Birth

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Child 6 :

Name

Date of Birth

Place of Birth

Address :

Suburb :

Postcode

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Prayer Ward (Kudumbakoottayma):

Prayer Ward:

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Contribution Number ( Enter the Contribution Number assigned to your family. If none yet - please enter N/A)

Yearly Pledge Status ( Pledged / Would like to make Yearly Pledge - if yes please enter the amount below)

Kerala/India Location details ( Please specify where you/your family are originally from)

Diocese ( Please specify the Diocese you/your family are originally from)

Extra details ( Additional email address, mobile number, comments etc)

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By completing this form, I consent to The St Thomas' Syro-Malabar Parish of Melbourne Southeast using the provided information responsibly and maintaining confidentiality in accordance with the Eparchy Privacy Policy. (https://syromalabar.org.au/privacy-policy)