New Parishoners Web Sign Up Form

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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.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. 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.
- Date of Birth Please enter a date.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number Please enter a phone number.
- Cell Number REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Provider REQUIRED Please fill out this field. Please enter valid data.
- Spouse's Name Please enter valid data.
- Date of Birth Please enter a date.
- Children's Names & Date of Birth (list all)
- Special Areas of Interest or Need
- 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.
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