Become a Member Step 1 of 4 25% Family InformationDate of submission MM slash DD slash YYYY Family Name Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email PhonePhone Number Type Home Phone Mobile Phone Work Phone House Hold SizeHouse Hold Size123456+Includes number of people living in your home.Family PhotoPlease include a photo of your family or yourself (if single.) This will be for parish use only. It helps Fr. Nick and Staff place a face with the name.Max. file size: 32 MB.Photo PermissionsDo you give permission for your photo to be used by St. Nicholas Parish Community on their social media pages? Yes. St. Nicholas Parish Community has my permission to use the uploaded photo on their social media. No. St. Nicholas Parish Community is NOT to use my photo on social media. Heads of HouseholdMarital StatusMarital StatusSingleMarriedDivorcedWidowedSeperatedMarried in the Catholic Church Married in the Catholic Church NOT Married in the Catholic Church Date of Marriage MM slash DD slash YYYY I am theI am the...HusbandWifeGender Male Female My Name First Last (Maiden Name if Wife) My Birthday MM slash DD slash YYYY My Occupation My Religion My Baptism Status Baptized Not Baptized My First Communion Status Completed First Communion Did Not Complete First Communion My Confirmation Status Completed Confirmation Did Not Complete Confirmation Spouce Name First Last (Maiden Name if Wife) Spouse Birthday MM slash DD slash YYYY Spouse Occupation Spouse Religion Spouse Baptism Status Baptized Not Baptized Spouse First Communion Status Completed First Communion Did Not Complete First Communion Spouse Confirmation Status Completed Confirmation Didi Not Complete Confirmation Children and Others at HomeDo you have a child I Have Children I DO NOT Have Children Number of Children 1 Child 2 Children 3 Children 4 Children Do you have any others living in your home I have others living in my home I DO NOT have others living in my home does not include childrenElderly or Other Hosehold MemberElderly/Other Household Member First Last Elderly/Other Household Member Religion Elderly/Other Household Member Birthday MM slash DD slash YYYY Elderly/Other Household Member RelationshipMotherFatherMother In-lawFather In-lawSiblingOtherChild 1Child 1 First Last Child 1 Gender Male Female Child 1 Birthday MM slash DD slash YYYY Child 1 Religion Child ProgressCheck all that apply Baptised Completed First Communion Completed Confirmation Child 2Child 2 First Last Child 2 Gender Male Female Child 2 Birthday MM slash DD slash YYYY Child 2 Religion Child 2 ProgressCheck all that apply Baptised Completed First Communion Completed Confirmation Child 3Child 3 First Last Child 3 Gender Male Female Child 3 Birthday MM slash DD slash YYYY Child 3 Religion Child 3 ProgressCheck all that apply Baptised Completed First Communion Completed Confirmation Child 4Child 4 First Last Child 4 Gender Male Female Child 4 Birthday MM slash DD slash YYYY Child 4 Religion Child 4 ProgressCheck all that apply Baptised Completed First Communion Completed Confirmation CAPTCHA Δ Let's Connect 625 St. Nicholas Dr., O'Fallon, IL 62269 (618) 632-1797 Parish Office Hours Mon – Fri | 9:00AM – 4:30PM Name First Email Post BodyCAPTCHACommentsThis field is for validation purposes and should be left unchanged. 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