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Immaculate Conception Church

16 N. Broadway
Irvington, NY 10533
914-591-7480

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Registration in the Parish

- Registering at ICC is quick and easy!
  
  Just fill out the form below and click Submit—we’ll add you to the roster right away.
  
  Prefer to register in person? You're more than welcome!
  
  Our team is here to help Monday through Friday, from 9 AM to 4 PM.
- 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.
  
  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.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  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.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  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.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  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.
  
  Did you receive the Sacrament of First Holy Communion? REQUIRED Please fill out this field.
  
  Did you receive the Sacrament of Confirmation? REQUIRED Please fill out this field.
  
  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.
  
  Submit

16 N Broadway, Irvington, NY 10533 / Phone: (914) 591-7480 / Fax: (914) 591-7806 / Email: [email protected]

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