Parish Verification Form

Immaculate Heart of Mary Parish Families Only
(Please attach a picture of your family to this verification form)

Parents/Guardians Name REQUIRED Please fill out this field. Please enter valid data.

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

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

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

Work Number Please enter a phone number.

Street 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.

Our family has stewardship pledge on file with the Parish this year Yes No Not Sure

Our family participates in this year's Archbishop Annual Appeal Yes No Not Sure

Name of Parish Please enter valid data.

Date Registered Please enter a date.

Please list ALL students planning to attend IMMACULATE HEART OF MARY SCHOOL for the 2023-2024 school year even if acceptance has not been finalized. List all students' first and last names and the grade they will be entering.

Number of Students Attending IHM School REQUIRED Please fill out this field.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.
Student 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.
- Grade in 2023-2024 REQUIRED Please fill out this field. Please enter valid data.

The information on this form is held in the strictest confidence. Please be as specific as possible. Attach additional information if needed.

We attend Mass: Regularly Frequently Infrequently Never

Please list the ways that you and/or your spouse and children are involved in the ministries and activities of your parish REQUIRED Please fill out this field.

We would like more information about volunteering at the parish REQUIRED Yes No Please fill out this field.

Please list all the volunteer activities in which you have participated at school/pre-school REQUIRED Please fill out this field.

STEWARDSHIP OF TREASURE

Contributions are made to the Parish Weekly Monthly Other (please specify)

Method of Contribution REQUIRED Envelope Check Cash Electronic Please fill out this field.

Note: Cash contributions should be placed in parish offertory envelopes. Unfortunately, loose cash cannot be identified as yours and, therefore, will not count toward verification.

New Families Only - Please indicate your child/children's religious education involvement

For Parish Office Use Only:

This family is registered at Please enter valid data.

This family is not registered at Please enter valid data.

Based on the commitment of Time, Talent and Treasure, this family is considered: Active____ Non Active____ Not Catholic____ Please enter valid data.

Pastor's comments to support this designation

Signature _____________________________ Please enter valid data.

Date _____________________ Please enter valid data.