St. Leo Parish Census Form

St. Leo IV Catholic Church

7166 Roberts Cove Rd., Rayne, LA 70578

Phone: (337) 334-5056

St. Edmund Chapel

8355 Branch Hwy., Branch, LA 70516 

Family's Last Name   Date

Mailing Address City State Zip

Physical Address (if different) City State Zip

Phone:  Home   Work   Cell

Status: Married Single Widowed Separated Divorced        Email address

Were you married by a Catholic Priest Yes No               Wife's maiden name

Would you like to receive offertory envelopes Yes No

First Name

Date of Birth

Baptized

Catholic

If not, would you like to become Catholic?

Church of Baptism

City & State of Baptism

First Communion

Confirmed

Attend Mass Regularly

Race

Occupation

Mr.  

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Miss/Mrs.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

 Children living with you. Include last name if different from family name above.

Grade

School Name

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Other persons living with you 

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

 

Who should be notified in an emergency?    Phone

Is there a shut-in at your home who would like to receive communion? Yes No   Name

Ministries / Organizations:

   I would like information on taking part in an Adult Education Program. Yes No

   I would like information on the following parish ministries / organizations:

   Please list any ministries / organizations you currently belong to:

Any additional comments:  

Thank you for your cooperation.

All information will be treated confidentially.