The Church of Saint Timothy in West Hartford, CT

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Last Name:		Telephone:
Address:		Email Address: Date:

Complete the below chart with info on ALL persons living at the above address starting with yourself:

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Wife's Maiden name
and/or family name
if other than above

Date Of Birth (MM/DD/YY)

Relationship

Religion

Baptism?

First Comm?

Confir-mation?

Church Attendance

Marital Status

Present School or Occupation

Grade or Term

Attending C.C.D.?

What observations, suggestions, recommendations would you like to make concerning St. Timothy's Parish?

What abilities, talents, or personal areas of interest would you like to share as a volunteer?

Other comments or suggestions:

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