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Parish Census

Head of Household

Address(Required)
Date of Marriage (if applicable)
Date of Birth(Required)
If yes, please select all that apply:

Spouse (if applicable)

Date of Birth
If yes, please select all that apply:

Children Living At Home (if applicable)

Note: If your child is an adult [over 18 years of age & NOT attending college] and living at home, they will need to complete a separate form.

Date of Birth

Date of Birth

Date of Birth

Date of Birth

Date of Birth

Date of Birth

Other Family Members Living At Home (if applicable)

More Information

Would you or any family member be willing to be any of the following? (Please check all that apply)