St. Raphael's, Rockville, MD
Parish Registration Form

- About

Welcome to St. Raphael! To register your family in the parish, please click on the “Parish Registration Form” link below. You may print it, complete it, and drop off or mail the form to the parish office or you may fill out the online form below.

Please make a note if you would like to receive offertory envelopes or if you will enroll in online giving. Thank you.

Parish Registration Form
Register Online at St. Raphael's in Rockville, MD
The maximum number of form submissions has been reached. This form is currently not available.
- Date REQUIRED Please fill out this field. Please enter a date.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Home Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- We have needs regarding; Baptism First Reconciliation First Eucharist Confirmation Marriage
- Language spoken at home (if other than English) Please enter valid data.
- Race REQUIRED Asian Black Caucasian/White Hispanic Other Please fill out this field.
- We Would Like a Priest to Call Yes No
- Number of People in Household REQUIRED Please fill out this field.
  
  Person in Household 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
  
  Person in Household 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Race Please enter valid data.
  
  Catholic
  
  Baptized
  
  First Eucharist
  
  Confirmed
  
  Marital Status
  
  Grade Level (Child) Please enter valid data.
  
  Attend Mass Regularly
  
  Occupation Please enter valid data.
- I am interested in learning about the following ministries at St. Raphael: Catechetical Formation Knights of Columbus Liturgical Ministries Men's Fellowship Music Ministry Respect for Life Social Responsibility and Outreach Sodality Youth Ministry
- Please indicate how you would like to donate to the parish: Offertory Envelopes Online Giving
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

St. Raphael's, Rockville, MD Parish Registration Form

St. Raphael's, Rockville, MD
Parish Registration Form