New Parishioner Web Sign Up Form

- Faith

New Parishioner Form

Welcome to Our Lady of Prompt Succor Catholic Church in Coteau, Louisiana.

To become an official member of our Church parish, we ask that you complete the New Parishioner information form below and submit it to the Church office. We will not share your information or email address with anyone outside of our office.

CLICK HERE to view a map of our Church location.
New Family Sign-Up
The maximum number of form submissions has been reached. This form is currently not available.
- Head of Household - Last Name REQUIRED Maximum 25 characters Please fill out this field. Please enter valid data.
- Head of Household First Name REQUIRED Maximum 15 characters Please fill out this field. Please enter valid data.
- Head of Household-Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Head of Household Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Head of Household Cell Phone Service Provider REQUIRED Please fill out this field. Please enter valid data.
- Head of Household E-mail Address REQUIRED Please fill out this field. Please enter an email address.
- Spouse's First Name
  Full Name if different from Head of Household
  Please enter valid data.
- Spouse's-Date of Birth Please enter a date.
- Spouse Cell Phone Number Please enter valid data.
- Spouse Cell Phone Service Provider Please enter valid data.
- Spouse's E-Mail Address Please enter valid data.
- 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.
- Marital Status REQUIRED Single Church Marriage Civil Marriage Co-Habitation Divorced Widowed Please fill out this field.
- Children's Names & Date of Birth (list all)
- Special Areas of Interest or Need
- Check the box below if you want to receive church envelopes for your weekly offering.
  I Agree Please select this field.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- I Agree to allow Our Lady of Prompt Succor Catholic Church to use my provided information to contact me as needed. Please select this field.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.