Registering as a Parishioner

- Contact

Attending Mass regularly at the Basilica but
have never officially Registered?

Some people attend Mass for several years, but never register. Parish membership allows us to mutually turn to each other for support and service.

Being a registered parishioner makes the process much easier when it is time for infant baptism, school or religious education registration, weddings, when asked to be a baptismal or confirmation sponsor and even funerals.

A registered parishioner receives all parish mailings. Anyone who would like to share in the life of the parish can register by completing the online registration form found below:
The maximum number of form submissions has been reached. This form is currently not available.
- Family Information
  
  Family Name REQUIRED 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 Please enter a phone number.
- Number of Family Members REQUIRED Please fill out this field.
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
  
  Individual 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.
  
  Title
  
  Maiden Name Please enter valid data.
  
  Preferred Name Please enter valid data.
  
  Family Relationship
  
  If other... Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Marital Status
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Religious Denomination Please enter valid data.
  
  Ethnic Background Please enter valid data.
  
  Language(s) English Polish Spanish Other
  
  If other... Please enter valid data.
  
  Occupation Please enter valid data.
  
  Employer Please enter valid data.
  
  Cellular Number Please enter a phone number.
  
  Work Number Please enter a phone number.
  
  Email Address Please enter an email address.
  
  Highest Level of Education Please enter valid data.
  
  List degrees, licenses, and/or certificates Please enter valid data.
  
  Are you an Alumnus of Saint Josaphat Parish School Yes No
  
  If yes, what year did you graduate? Please enter an integer (number).
  
  Sacramental Information
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Marriage (By a Priest?) REQUIRED Yes No Please fill out this field.
  
  Approximate Date Please enter a date.
  
  Church & City/State Please enter valid data.
  
  Activites
  
  (Please use this sheet to select the appropriate codes; complete for each member age 5 and older)
  
  Talents
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Current Parish Involvement
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Groups interested in being involved
  Please separate codes by slashes
  Please enter valid data.
  
  Other Please enter valid data.
  
  Additional Information
  
  Are you home bound? Yes No
  
  Do you need to receive Communion at home? Yes No
  
  Do you reside in a nursing home? Yes No
  
  If yes, please provide the name and the address of the nursing home below
  
  Do you have any special needs or impairments? Yes No
  
  If yes, please describe
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Contact Us
- Mrs. Sharon Markowiak
  
  Parish Secretary
  
  (414) 645-5623 ext. 210
  smarkowiakthebasilica.org