Registration

Welcome to Blessed Sacrament Parish!
If you need help with this form or prefer to speak with someone about your registration, please call the rectory at 914.632.3700 M-F 9am-4pm. If you leave a message, someone will call you back.

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 Address REQUIRED Please fill out this field. 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.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Marital Status Single Married Divorced Widowed Separated Other: Living Together

Family Members

Please list other members of your household who you are also registering in the parish.
First Name Please enter valid data.

Last Name Please enter valid data.
Relationship to you Spouse Child Another Adult Living in the Household
First Name Please enter valid data.

Last Name Please enter valid data.
Relationship to you Spouse Child Another Adult Living in the Household

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship to you Spouse Child Another Adult Living in the Household

List additional family members below. Please enter valid data.

Would you like to enroll children in our Religious Education Program? Yes No

Would you like to receive weekly offertory envelopes, or do you prefer to make your donations on-line? REQUIRED Weekly Envelopes Make On-line Donations Please fill out this field.

Blessed Sacrament Church

New Rochelle, N.Y.

Registration

Registration Form