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Immaculate Conception

Irvington, NY

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Registration in the Parish

- Registering at ICC is fast and simple online. Simply complete the form below and hit submit, and we will add you to the roster right away. If you prefer to come in, you are certainly welcome to do so. We are here to help you Monday - Friday from 9AM - 4PM.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  New Family Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing Name Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  Building, Apt. or Box Number
  Please enter this information to facilitate delivery.
  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 REQUIRED Please fill out this field. Please enter a phone number.
  
  Cell Phone Number Please enter valid data.
  
  Main Email REQUIRED
  The email you would like to be used for Parish communications.
  Please fill out this field. Please enter an email address.
  
  Have you registered in the Parish before? Yes No
  
  If you registered before, please provide your envelope number. Please enter valid data.
  
  Are you Catholic? Yes No
  
  Would you like to receive our weekly email newsletter?
  Please note that if you check "No" you may not receive important Parish information in a timely manner.
  Yes No
  
  Are there any members of your household who would like a visit from a Priest? Yes No
  
  Is there any special request or question you have for our Priests or concerning your family?
  
  Adults in Household REQUIRED
  Please complete the following fields for each adult member of your household.
  Please fill out this field.
  
  Adult 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.
  
  Nickname
  Indicate your nickname if you would like us to use it.
  Please enter valid data.
  
  Household Role REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Were you Baptized? REQUIRED Please fill out this field.
  
  Date of your Baptism Please enter a date.
  
  Church of your Baptism Please enter valid data.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Date of your First Holy Communion Please enter a date.
  
  Church of your First Holy Communion Please enter valid data.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  Date of your Confirmation Please enter a date.
  
  Church of Confirmation Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Date of Marriage (if applicable) Please enter a date.
  
  Church of Marriage (if applicable) Please enter a date.
  
  Adult 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.
  
  Nickname
  Indicate your nickname if you would like us to use it.
  Please enter valid data.
  
  Household Role REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Were you Baptized? REQUIRED Please fill out this field.
  
  Date of your Baptism Please enter a date.
  
  Church of your Baptism Please enter valid data.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Date of your First Holy Communion Please enter a date.
  
  Church of your First Holy Communion Please enter valid data.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  Date of your Confirmation Please enter a date.
  
  Church of Confirmation Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Date of Marriage (if applicable) Please enter a date.
  
  Church of Marriage (if applicable) Please enter a date.
  
  Adult 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.
  
  Nickname
  Indicate your nickname if you would like us to use it.
  Please enter valid data.
  
  Household Role REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Were you Baptized? REQUIRED Please fill out this field.
  
  Date of your Baptism Please enter a date.
  
  Church of your Baptism Please enter valid data.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Date of your First Holy Communion Please enter a date.
  
  Church of your First Holy Communion Please enter valid data.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  Date of your Confirmation Please enter a date.
  
  Church of Confirmation Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Date of Marriage (if applicable) Please enter a date.
  
  Church of Marriage (if applicable) Please enter a date.
  
  Adult 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.
  
  Nickname
  Indicate your nickname if you would like us to use it.
  Please enter valid data.
  
  Household Role REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Were you Baptized? REQUIRED Please fill out this field.
  
  Date of your Baptism Please enter a date.
  
  Church of your Baptism Please enter valid data.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Date of your First Holy Communion Please enter a date.
  
  Church of your First Holy Communion Please enter valid data.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  Date of your Confirmation Please enter a date.
  
  Church of Confirmation Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Date of Marriage (if applicable) Please enter a date.
  
  Church of Marriage (if applicable) Please enter a date.
  
  Dependent Children REQUIRED Please fill out this field.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Dependent Chidren 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Catholic? Yes No
  
  Date of Baptism Please enter a date.
  
  Date of First Holy Communion Please enter a date.
  
  Date of Confirmation Please enter a date.
  
  Would you like to receive regular collection envelopes, or make your donations online? REQUIRED Please fill out this field.
  
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16 N Broadway, Irvington, NY 10533 / Phone: (914) 591-7480 / Fax: (914) 591-7806 / Email: immacon@optonline.net

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