Parish of Immaculate Conception and Assumption of Our Lady

The Churches of Eastchester and Tuckahoe

53 Winter Hill Road   ·   Tuckahoe, NY 10707   ·   (914) 961-3643   ·   fax: (914) 961-0283

53 Winter Hill Road   ·   Tuckahoe, NY 10707
(914) 961-3643   ·   fax: (914) 961-0283

Register as a Parishioner


Please complete and submit this registration form. Your registration will take a few days to process.
You can also print and complete a registration form.


Household  
Information:

Street Address*:     Apartment:

City, State*:     Zip Code:

Home Phone*:

Marital Status*:

Wedding Date:     Church and Location of Marriage:


Male Head  
of Household:

Title*   First Name*:     Last Name*:

Birth Date*:             Religion*:

Sacraments Received* (check all that apply)
Baptism         Communion         Confirmation

E-Mail Address:

Alternate Phone(s):


Female Head  
of Household:

Title*:   First Name*:     Maiden Name:

Last Name*:

Birth Date*:             Religion*:

Sacraments Received* (check all that apply)
Baptism         Communion         Confirmation

E-Mail Address:

Alternate Phone:


Donation  
Options:

Do you want to receive Collection Envelopes?
Yes No

Do you want to receive information about Electronic Giving?
Yes No


If there are no children in the household, move down the page


Children in the
Household:


First Child:

Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation

If there are no more children in the household, move down the page


Second Child:


Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation

If there are no more children in the household, move down the page


Third Child:


Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation

If there are no more children in the household, move down the page


Fourth Child:


Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation

If there are no more children in the household, move down the page


Fifth Child:


Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation

If there are no more children in the household, move down the page


Sixth Child:


Full Name: Birth Date:

Gender:
Female Male

Religion:

Sacraments Received (check all that apply)
Baptism     Communion     Confirmation


Religious  
Education

Please let us know if you have a child who will be attending:

Immaculate Conception School     Our Religious Education Program (after school/evenings)

More  
Information:

We realize that this form may not fully communicate your household situation. If you have additional children, elderly parents, other members of the household, people who are homebound and would like someone to bring communion, other requests or comments, please let us know - and make sure you have included an e-mail address or daytime contact information

Please contact me about additional information (check all that apply):

More Children in the Household         More Adults in the Household    
Homebound Household Members     Requests or Comments    

Daytime Contact Information (e-mail or phone):

If you have any questions about this form, or would like to speak with a priest or staff member, please call the rectory: 914-961-3643.


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