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Home
About
Liturgy & Sacraments
- Worship With Us
- Sacraments
Faith Formation
Ministries
Beacons of Light
- - Beacons of Light Leadership Team
  - Archdiocese of Cincinnati - Beacons of Light

Parishioner Registration Form

- Welcome
  
  Please complete the form below to register with St. Bernard of Clairvaux Catholic Church. Please contact the rectory at 513-353-4207 if you have any questions or for additional information.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family Contact Information
  
  Male Head of Household Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date of birth REQUIRED Please fill out this field. Please enter a date.
  
  Indicate all sacraments received REQUIRED Baptism First Eucharist/Reconciliation Confirmation Please fill out this field.
  
  Occupation Please enter valid data.
  
  Female Head of Household Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date of birth REQUIRED Please fill out this field. Please enter a date.
  
  Indicate all sacraments received REQUIRED Baptism First Eucharist/Reconciliation Confirmation Please fill out this field.
  
  Occupation Please enter valid data.
  
  Home Address REQUIRED Please fill out this field. Please enter valid data.
  
  Address Line 2 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.
  
  Is it okay to e-mail letters from the parish to you? Yes No
  
  Marital Status REQUIRED Please fill out this field.
  
  Marriage Details (if applicable)
  
  Date of wedding Please enter a date.
  
  Location of wedding Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Type of wedding
  
  If non-Catholic spouse or children, what religion do they practice? Please enter valid data.
  
  Children REQUIRED Please fill out this field.
  
  Child 1
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 2
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 3
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 4
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 5
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 6
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 7
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 8
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 9
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  Child 10
  
  Full Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School & Grade Please enter valid data.
  
  Baptism Yes No
  
  First Communion Yes No
  
  Confirmed? Yes No
  
  If your children are no longer living at home, please include contact name & phone # of adult child or other family member
  
  Please include talents or training (example: teacher, plumber, electrician, artist...)
  
  Submit
  
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