e-Registration Form

The maximum number of form submissions has been reached. This form is currently not available.

New Registration or Update Information REQUIRED New Update Please fill out this field.
Family Name REQUIRED Maximum 20 characters Please fill out this field. Please enter valid data.
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.
Home Phone Number Maximum 20 characters Please enter a phone number.
Cell Phone Number Maximum 20 characters Please enter a phone number.
Your Email Please enter an email address.
First Name Please enter valid data.

Last Name Please enter valid data.
Middle Name (Catholic) Maximum 20 characters Please enter valid data.
Gender Male Female
Maiden Name (Catholic) Please enter valid data.
Date of Birth (Catholic) Please enter a date.
Occupation Please enter valid data.
Work Phone Number Maximum 20 characters Please enter a phone number.
Sacraments Received
- Place of Baptism (Parish Name) Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Sacraments of Initiation Eucharist Confirmation
- Reconciliation Reconciliation
- Would you like to talk with the Priest or Deacon about preparing to receive either Eucharist, Confirmation or Reconciliation? Yes
Marital Status Single Widowed Married Marriage Performed in the Presence of a Priest or Deacon of the Catholic Church Would you like to speak with a Priest or Deacon about having your marriage "blest" by the Church? Divorced Annuled by the Church Would you like to speak with a Priest or Deacon about an annulment ?
Please call the Parish office at 517-487-3749 to schedule a meeting with the Pastor to complete this registration form and process.

Submit

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

St. Therese of Lisieux

102 W. Randolph St., Lansing, MI

e-Registration Form

e-Registration or Update Information