R.C.I.A. REGISTRATION FORM

R.C.I.A. REGISTRATION FORM
Rite of Christian Initiation of Adults
(For an adult who is to be Baptized or who is making a Profession of Faith,
along with Confirmation & First Holy Eucharist)
Please Print Clearly
Last Name: ___________________________ Maiden Name (if applicable): ___________________________
Given Name(s): ___________________________________________ M F
Address: _________________________________________________ City/Town: ______________________
Province: ___________ Postal Code: ____________ Phone: (hm) ___________(wk) ________________
Date of Birth: ________________ Place of Birth: _____________________________________________
Day / Month / Year City/Town Province Country
Father’s Name: _________________________________________________________________________
Last Name
Given Name(s)
Mother’s Name: ________________________________________________________________________
Maiden Name
Given Name(s)
A copy of your Birth Certificate with parents’ names is required at the time of registration.
A copy of your Baptism Certificate is required at the time of registration (if applicable).
Were you Baptized in the Orthodox Church □Y □ N Confirmed at the time of Baptism □Y □ N
On making a Profession of Faith, you will be become a member of the corresponding Eastern
Church within the Catholic Church.
Were you Baptized in another Christian ecclesial community □Y □ N
If yes, which denomination __________________
On making a Profession of Faith, you will be received into the Roman Catholic Church.
SPONSOR:
One sponsor, male or female, is sufficient; but there may be two, one of each gender. (c.873)
The sponsor must not be either the father or the mother of the one to be baptized. (c.874 §1,5)
The sponsor must have received the sacraments of Baptism, Confirmation and Eucharist, be a practicing
Catholic, and be at least 16 years of age. (c.874)
Sponsor:
____________________________________________________________________________ □ M □ F
Last Name Given Name(s) Date of Baptism/Confirmation & Parish
_________________________________________________________________________ □ M □ F
Last Name Given Name(s) Date of Baptism/Confirmation & Parish
If the sponsor cannot attend the Easter Vigil, who will stand as proxy
________________________________________________________________________________________
Last Name
Given Name(s)
(Revised 2010)

RCIA Checklist for Office Use:
Date of first interview: ______________________________________________________
Baptism
Current marriage
‣ Proof of baptism received Yes No
‣ Is baptism valid Yes No
‣ Is convalidation required Yes No
‣ Date completed __________________________________________________
Previous marriages
Is declaration of nullity required
for candidate/catechumen Yes No Decree received
for spouse/fiancée Yes No Decree received
Accepted for RCIA Yes No

MARRIAGE INFORMATION – RCIA
The following questions are to be completed for anyone who is married, engaged to be married, or previously, but
not currently married.
*If you were previously, but not currently married move on to Section II.
I. CURRENT MARRIAGE/ENGAGEMENT INFORMATION
a) If you are currently married or engaged, is this your first marriage Yes No
b) If you are currently married, who presided at your wedding
Priest non-catholic minister justice of peace other
c) If your current marriage was not celebrated in a Catholic Church:
i) Did you ask for and receive dispensation Yes No
ii) If no, has this present marriage been convalidated (“blessed”) or brought into the
Catholic Church Yes No
d) Name of current spouse/fiancée: ____________________________________________
e) Is current spouse/fiancée baptized Yes No If yes, denomination ___________
f) Is this a first marriage for your current spouse/fiancée Yes No
*If you answered No to question I (a) move on to Section II.
If you answered No to question I (f) move on to Section III.
II.
PREVIOUS MARRIAGES
How many times have you been married before your current marriage/engagement ________________
Note: For each of your previous marriages, the following information is needed.
MOST RECENT PREVIOUS MARRIAGE
1. Date of marriage (D/M/Y): _____________ City, Province of marriage: ________________
2. How were you married (Catholic Church, Christian Church, Justice of the Peace, Common
Law, other)____________________________
3. Your previous spouse’s name: _______________________________________________
4. Is your previous spouse still living Yes No Not sure
5. Was this a first marriage for your previous spouse Yes No
6. Was your previous spouse baptized Yes No Denomination _____________
7. Are you divorced Yes No Pending
8. Have you received a declaration of nullity Yes No Pending
9. What diocese granted the declaration of nullity, or is currently processing the request
________________________________________________________________________
2 nd MOST RECENT PREVIOUS MARRIAGE
1. Date of marriage: _________________ _ City, Province of marriage: ________________
2 How were you married (Catholic Church, Christian Church, Justice of the Peace,
Common Law, other) ______________________________________________________

3. Your previous spouse’s name: _______________________________________________
4. Is your previous spouse still living Yes No Not sure
5. Was this a first marriage for your previous spouse Yes No
6. Was your previous spouse baptized Yes No Denomination _____________
7. Are you divorced Yes No Pending
8. Have you received a declaration of nullity Yes No Pending
9. What diocese granted the declaration of nullity, or is currently processing the request
________________________________________________________________________
III.
PREVIOUS MARRIAGES FOR SPOUSE/FIANCEE
How many times has your spouse/fiancée been married before your current/pending marriage ________
Note: For each of your spouse/fiancée’s previous marriages, the following information is needed.
SPOUSE/FIANCEE’S MOST RECENT PREVIOUS MARRIAGE
1. Date of marriage (D/M/Y): _____________ City, Province of marriage: ________________
2. How were they married (Catholic Church, Christian Church, Justice of the Peace,
Common Law, other) ______________________________________________________
3. Name of your spouse/fiancée’s previous spouse: ________________________________
4. Is your spouse/fiancée’s previous spouse still living Yes No Not sure
5. Was he/she baptized Yes No Denomination____________________________
6. Are they divorced Yes No Pending
7. Have they received a declaration of nullity Yes No Pending
8. What diocese granted the declaration of nullity, or is currently processing the request
______________________________________________________________________
SPOUSE/FIANCEE’S 2 ND MOST RECENT PREVIOUS MARRIAGE
1. Date of marriage (D/M/Y): _____________ City, Province of marriage: ________________
2. How were they married (Catholic Church, Christian Church, Justice of the Peace,
Common Law, other) _____________________________
3. Name of your spouse/fiancée’s previous spouse: ________________________________
4. Is your spouse/fiancée’s previous spouse still living Yes No Not sure
5. Was he/she baptized Yes No Denomination ___________________________
6. Are they divorced Yes No Pending
7. Have they received a declaration of nullity Yes No Pending
8. What diocese granted the declaration of nullity, or is currently processing the request
________________________________________________________________________
(Revised 2010)