The Church of Saint Timothy in West Hartford, CT

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Last Name:		Telephone:
Address:		Date:

Complete the below chart with info on ALL persons living at the above address starting with yourself:

Name of person	Wife's Maiden name and/or family name if other than above	Date Of Birth (MM/DD/YY)	Relationship	Baptism?	First Comm?	Confir-mation?	Church Attendance	Marital Status	Present School or Occupation	Grade or Term	Attending C.C.D.?

What observations, suggestions, recommendations would you like to make concerning St. Timothy's Parish?

What abilities, talents, or personal areas of interest would you like to share as a volunteer?

Other comments or suggestions:

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