Ocia online inquire form

Adult Inquirer Information Form
Information on this form is held in confidence and is not shared without your permission.

Date: REQUIRED

Today's Date

Please fill out this field. Please enter a date.

First Name: REQUIRED Please fill out this field. Please enter valid data.

Middle Name Please enter valid data.

Last Name: REQUIRED Please fill out this field. Please enter valid data.

Maiden Name (if applicable): Please enter valid data.

Date of Birth: REQUIRED Please fill out this field. Please enter a date.

Age: REQUIRED Please fill out this field. Please enter an integer (number).

Place of Birth: REQUIRED

(include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)

Please fill out this field. Please enter valid data.

Name of Father: REQUIRED Please fill out this field. Please enter valid data.

Name of Mother: REQUIRED Please fill out this field. Please enter valid data.

I. Contact Information

Full Mailing Address: REQUIRED
Street, City, State, Zip Code
Please fill out this field. Please enter valid data.
Phone Number (Daytime): REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Phone Number (Evening/Weekend): Maximum 20 characters Please enter a phone number.
Cell/Mobile Phone Number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Occupation: REQUIRED Please fill out this field. Please enter valid data.
Email (Other): REQUIRED Please fill out this field. Please enter an email address.
Email (Home): Please enter an email address.

II. Religious History

1. What, if any, is your present religious affiliation? REQUIRED Please fill out this field. Please enter valid data.
2. Have you ever been baptized? REQUIRED Yes No I am not sure Please fill out this field.
If you answered “Yes” to Question 2, please provide the following information:
a) In what denomination were you baptized? REQUIRED Please fill out this field. Please enter valid data.
b) Date or your approximate age when you were baptized: REQUIRED Please fill out this field. Please enter valid data.
c) Baptismal name (if different from current name): Please enter valid data.
d) Place of Baptism (name of church/denomination): REQUIRED Please fill out this field. Please enter valid data.
e) Address, if known: Please enter valid data.
f) Location, if known:
(include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)
Please enter valid data.
3. If you were baptized as a Catholic, check those sacraments you have already received: REQUIRED Penance (Confession) Eucharist (First Communion) Confirmation Please fill out this field.

III. Current Marital Status

1. Check the appropriate statement(s) below and provide any information requested beneath each statement: REQUIRED I have never been married. I am engaged to be married. I am married. I am married, but separated from my spouse. I am divorced and I have not remarried. I am a widow/widower and have not remarried since my spouse’s death. Please fill out this field.

2. If you answered I am engaged to be married:

a) Your Fiancé(e)’s Name: Please enter valid data.

b) Your Fiancé(e)’s Current Religious Affiliation (if any): Please enter valid data.

c) For you: This is my first marriage. I have been married before.

d) For your fiancé(e): This is his/her first marriage. My fiancé(e) has been married before.

3. If you answered I am married:

a) Your Spouse’s Name: Please enter valid data.

b) Your Spouse’s Current Religious Affiliation (if any): Please enter valid data.

c) For you: This is my first marriage. I have been married before.

d) For your spouse: This is my spouse's first marriage. My spouse has been married before.

e) Date of Marriage: Please enter a date.

f) Place of Marriage:

(include locality (town, city, county, etc.), region (state, province, territory, etc.), and country

Please enter valid data.

(g) Officiating Authority of Marriage:

(civil government, non-Christian minister, Christian minister, Catholic cleric)

Please enter valid data.

IV. Family Information

List the name(s) of any children or other dependents (e.g., Daughter — Jane; Stepson — John):
1. Relationship, Name, and Age:
Example: Daughter, Jane, 12
Please enter valid data.
2. Relationship, Name, and Age:
Example: Daughter, Jane, 12
Please enter valid data.
3. Relationship, Name, and Age:
Example: Daughter, Jane, 12
Please enter valid data.
4. Relationship, Name, and Age:
Example: Daughter, Jane, 12
Please enter valid data.
5. Relationship, Name, and Age:
Example: Daughter, Jane, 12
Please enter valid data.

V. General Questions

1. What or who has led you to want to know more about the Catholic Faith? REQUIRED Please fill out this field.
2. Please describe the types of religious education you have received, as a child and as an adult. REQUIRED Please fill out this field.
3. What contact have you had with the Catholic Church to date? REQUIRED Please fill out this field.
4. What are some of the questions or concerns you have about the Catholic Church? REQUIRED Please fill out this field.
5. At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church? (please select one) REQUIRED A. I need much more information about the Catholic Church before I would consider joining. B. I am considering joining, but I am still unsure about it. C. I am fairly sure that I would like to join, but I still need some time to study and pray about it. D. I am fairly sure that I want to join the Catholic Church. Please fill out this field.

Our Lady of Perpetual Help