<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("rciareg_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(73) Dim arFormDBFields0(73) Dim arFormValues0(73) arFormFields0(0) = "Emailhome" arFormDBFields0(0) = "Emailhome" arFormValues0(0) = Request("Emailhome") arFormFields0(1) = "Placeofmarriage" arFormDBFields0(1) = "Placeofmarriage" arFormValues0(1) = Request("Placeofmarriage") arFormFields0(2) = "SacramentPenance" arFormDBFields0(2) = "SacramentPenance" arFormValues0(2) = Request("SacramentPenance") arFormFields0(3) = "otherphone" arFormDBFields0(3) = "otherphone" arFormValues0(3) = Request("otherphone") arFormFields0(4) = "Mothersname" arFormDBFields0(4) = "Mothersname" arFormValues0(4) = Request("Mothersname") arFormFields0(5) = "Spousefirstmarriage" arFormDBFields0(5) = "Spousefirstmarriage" arFormValues0(5) = Request("Spousefirstmarriage") arFormFields0(6) = "PlaceofBaptism" arFormDBFields0(6) = "PlaceofBaptism" arFormValues0(6) = Request("PlaceofBaptism") arFormFields0(7) = "CellPhone" arFormDBFields0(7) = "CellPhone" arFormValues0(7) = Request("CellPhone") arFormFields0(8) = "Placeofbirth" arFormDBFields0(8) = "Placeofbirth" arFormValues0(8) = Request("Placeofbirth") arFormFields0(9) = "Age1" arFormDBFields0(9) = "Age1" arFormValues0(9) = Request("Age1") arFormFields0(10) = "Spousesreligiousaffiliation" arFormDBFields0(10) = "Spousesreligiousaffiliation" arFormValues0(10) = Request("Spousesreligiousaffiliation") arFormFields0(11) = "FiancesName" arFormDBFields0(11) = "FiancesName" arFormValues0(11) = Request("FiancesName") arFormFields0(12) = "LocationofBaptism" arFormDBFields0(12) = "LocationofBaptism" arFormValues0(12) = Request("LocationofBaptism") arFormFields0(13) = "Daytimephone" arFormDBFields0(13) = "Daytimephone" arFormValues0(13) = Request("Daytimephone") arFormFields0(14) = "maidenname" arFormDBFields0(14) = "maidenname" arFormValues0(14) = Request("maidenname") arFormFields0(15) = "Age2" arFormDBFields0(15) = "Age2" arFormValues0(15) = Request("Age2") arFormFields0(16) = "Name1" arFormDBFields0(16) = "Name1" arFormValues0(16) = Request("Name1") arFormFields0(17) = "DenominationofBaptism" arFormDBFields0(17) = "DenominationofBaptism" arFormValues0(17) = Request("DenominationofBaptism") arFormFields0(18) = "Fathersname" arFormDBFields0(18) = "Fathersname" arFormValues0(18) = Request("Fathersname") arFormFields0(19) = "DOB" arFormDBFields0(19) = "DOB" arFormValues0(19) = Request("DOB") arFormFields0(20) = "Question1" arFormDBFields0(20) = "Question1" arFormValues0(20) = Request("Question1") arFormFields0(21) = "Age3" arFormDBFields0(21) = "Age3" arFormValues0(21) = Request("Age3") arFormFields0(22) = "Name2" arFormDBFields0(22) = "Name2" arFormValues0(22) = Request("Name2") arFormFields0(23) = "widownotremarried" arFormDBFields0(23) = "widownotremarried" arFormValues0(23) = Request("widownotremarried") arFormFields0(24) = "Marriedbutseparated" arFormDBFields0(24) = "Marriedbutseparated" arFormValues0(24) = Request("Marriedbutseparated") arFormFields0(25) = "Emailother" arFormDBFields0(25) = "Emailother" arFormValues0(25) = Request("Emailother") arFormFields0(26) = "Question2" arFormDBFields0(26) = "Question2" arFormValues0(26) = Request("Question2") arFormFields0(27) = "Age4" arFormDBFields0(27) = "Age4" arFormValues0(27) = Request("Age4") arFormFields0(28) = "Name3" arFormDBFields0(28) = "Name3" arFormValues0(28) = Request("Name3") arFormFields0(29) = "Ihaveneverbeenmarried" arFormDBFields0(29) = "Ihaveneverbeenmarried" arFormValues0(29) = Request("Ihaveneverbeenmarried") arFormFields0(30) = "dateorapproxageatbaptism" arFormDBFields0(30) = "dateorapproxageatbaptism" arFormValues0(30) = Request("dateorapproxageatbaptism") arFormFields0(31) = "Question3" arFormDBFields0(31) = "Question3" arFormValues0(31) = Request("Question3") arFormFields0(32) = "Age5" arFormDBFields0(32) = "Age5" arFormValues0(32) = Request("Age5") arFormFields0(33) = "Name4" arFormDBFields0(33) = "Name4" arFormValues0(33) = Request("Name4") arFormFields0(34) = "Spousehasbeenmarriedbefore" arFormDBFields0(34) = "Spousehasbeenmarriedbefore" arFormValues0(34) = Request("Spousehasbeenmarriedbefore") arFormFields0(35) = "MarriedMyfirstmarriage" arFormDBFields0(35) = "MarriedMyfirstmarriage" arFormValues0(35) = Request("MarriedMyfirstmarriage") arFormFields0(36) = "Spousesname" arFormDBFields0(36) = "Spousesname" arFormValues0(36) = Request("Spousesname") arFormFields0(37) = "Ihavebeenmarriedbefore" arFormDBFields0(37) = "Ihavebeenmarriedbefore" arFormValues0(37) = Request("Ihavebeenmarriedbefore") arFormFields0(38) = "AddressofBaptism" arFormDBFields0(38) = "AddressofBaptism" arFormValues0(38) = Request("AddressofBaptism") arFormFields0(39) = "Question4" arFormDBFields0(39) = "Question4" arFormValues0(39) = Request("Question4") arFormFields0(40) = "Name5" arFormDBFields0(40) = "Name5" arFormValues0(40) = Request("Name5") arFormFields0(41) = "MarriedIhavebeenmarriedbefore" arFormDBFields0(41) = "MarriedIhavebeenmarriedbefore" arFormValues0(41) = Request("MarriedIhavebeenmarriedbefore") arFormFields0(42) = "Fiancefirstmarriage" arFormDBFields0(42) = "Fiancefirstmarriage" arFormValues0(42) = Request("Fiancefirstmarriage") arFormFields0(43) = "Iamengagedtobemarried" arFormDBFields0(43) = "Iamengagedtobemarried" arFormValues0(43) = Request("Iamengagedtobemarried") arFormFields0(44) = "FullName" arFormDBFields0(44) = "FullName" arFormValues0(44) = Request("FullName") arFormFields0(45) = "Relationship1" arFormDBFields0(45) = "Relationship1" arFormValues0(45) = Request("Relationship1") arFormFields0(46) = "Iammarried" arFormDBFields0(46) = "Iammarried" arFormValues0(46) = Request("Iammarried") arFormFields0(47) = "City" arFormDBFields0(47) = "City" arFormValues0(47) = Request("City") arFormFields0(48) = "Relationship2" arFormDBFields0(48) = "Relationship2" arFormValues0(48) = Request("Relationship2") arFormFields0(49) = "Divorcednotremarried" arFormDBFields0(49) = "Divorcednotremarried" arFormValues0(49) = Request("Divorcednotremarried") arFormFields0(50) = "age" arFormDBFields0(50) = "age" arFormValues0(50) = Request("age") arFormFields0(51) = "PossibilityofJoiningA" arFormDBFields0(51) = "PossibilityofJoiningA" arFormValues0(51) = Request("PossibilityofJoiningA") arFormFields0(52) = "Relationship3" arFormDBFields0(52) = "Relationship3" arFormValues0(52) = Request("Relationship3") arFormFields0(53) = "Myfirstmarriage" arFormDBFields0(53) = "Myfirstmarriage" arFormValues0(53) = Request("Myfirstmarriage") arFormFields0(54) = "SacramentConfirmation" arFormDBFields0(54) = "SacramentConfirmation" arFormValues0(54) = Request("SacramentConfirmation") arFormFields0(55) = "Occupation" arFormDBFields0(55) = "Occupation" arFormValues0(55) = Request("Occupation") arFormFields0(56) = "PossibilityofJoiningB" arFormDBFields0(56) = "PossibilityofJoiningB" arFormValues0(56) = Request("PossibilityofJoiningB") arFormFields0(57) = "Relationship4" arFormDBFields0(57) = "Relationship4" arFormValues0(57) = Request("Relationship4") arFormFields0(58) = "Dateofmarriage" arFormDBFields0(58) = "Dateofmarriage" arFormValues0(58) = Request("Dateofmarriage") arFormFields0(59) = "Baptized" arFormDBFields0(59) = "Baptized" arFormValues0(59) = Request("Baptized") arFormFields0(60) = "Zip" arFormDBFields0(60) = "Zip" arFormValues0(60) = Request("Zip") arFormFields0(61) = "PossibilityofJoiningC" arFormDBFields0(61) = "PossibilityofJoiningC" arFormValues0(61) = Request("PossibilityofJoiningC") arFormFields0(62) = "Relationship5" arFormDBFields0(62) = "Relationship5" arFormValues0(62) = Request("Relationship5") arFormFields0(63) = "todaysdate" arFormDBFields0(63) = "todaysdate" arFormValues0(63) = Request("todaysdate") arFormFields0(64) = "PossibilityofJoiningD" arFormDBFields0(64) = "PossibilityofJoiningD" arFormValues0(64) = Request("PossibilityofJoiningD") arFormFields0(65) = "OfficiateofMarriage" arFormDBFields0(65) = "OfficiateofMarriage" arFormValues0(65) = Request("OfficiateofMarriage") arFormFields0(66) = "Fiancehasbeenmarriedbefore" arFormDBFields0(66) = "Fiancehasbeenmarriedbefore" arFormValues0(66) = Request("Fiancehasbeenmarriedbefore") arFormFields0(67) = "Baptismalname" arFormDBFields0(67) = "Baptismalname" arFormValues0(67) = Request("Baptismalname") arFormFields0(68) = "currentreligiousaffiliation" arFormDBFields0(68) = "currentreligiousaffiliation" arFormValues0(68) = Request("currentreligiousaffiliation") arFormFields0(69) = "Fiancesreligiousaffiliation" arFormDBFields0(69) = "Fiancesreligiousaffiliation" arFormValues0(69) = Request("Fiancesreligiousaffiliation") arFormFields0(70) = "State" arFormDBFields0(70) = "State" arFormValues0(70) = Request("State") arFormFields0(71) = "Address" arFormDBFields0(71) = "Address" arFormValues0(71) = Request("Address") arFormFields0(72) = "SacramentEucharist" arFormDBFields0(72) = "SacramentEucharist" arFormValues0(72) = Request("SacramentEucharist") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "rciareg.htm",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Good Shepherd - RCIA Registration

RCIA:
Rite of Christian Initiation of Adults

Today's Date:
Full Name:
Maiden Name:
(if applicable)
 
Date of Birth:

Age:
Place of Birth:
(include locality (town, city, country etc.), region (state, province, territory, etc.) and country)
Father's Full Name:
Mother's Full Name:

I. Contact Information

Full Mailing Address:
City:

State:

Zip:
Phone: (Daytime) Evening/
Weekend:		 Cell:
Occupation:
Email: (Home)

(Other)

II. Religious History

1. What, if any, is your current religious affiliation?
2. Have you been baptized? Yes
No
I am not sure

    
     If you answered "Yes"to Question 2, please provide the following information:
     a) In what denomination were you baptized?     
     b) Date or your approximate age when you were baptized:
     c) Baptismal name (if different from current name):
     d) Place of Baptism (name of church/denomination):
     e) Address, if known:
     f) Location, if known:
                  (include locality (town, city, country etc.), region (state, province, territory, etc.) and country)
3. If you were baptized as a Catholic, check those sacraments you have already received:

Penance (Confession)          Eucharist (First Communion)           Confirmation     

III. Current Marital Status

Check the appropriate statement(s) below and provide any information requested beneath each statement.
1. I have never been married.
 2. I am engaged to be married.
               a) Your Fiance(e)'s Name:    
               b) Your Fiance(e)'s Current Religious Affiliation (if any):  
               c) For you: This is my first marriage.          I have been married before.
               d) For your Fiance(e): This is his/her first marriage.          My fiance(e) has been married before.    
3. I am married.
               a) Your Spouse's Name:  
               b) Your Spouse's Current Religious Affiliation (if any):                
               c) For you: This is my first marriage.          I have been married before.
               d) For your Spouse: This is his/her first marriage.          My Spouse has been married before.
               e) Date of Marriage:
               f) Place of Marriage:
                                                   (include locality (town, city, country etc.), region (state, province, territory, etc.) and country)
              g) Officiating Authority of Marriage:
                                                                                 (civil government, non-Christian minister, Christian Minister, Catholic cleric)

4. I am married, but separated from my spouse.
5. I am divorced and I have not remarried.
6. I am widow/widower and have not remarried since my spouse's death.

IV. Family Information

List the name(s) of any dependent(s) (e.g., Daughter - Jane; Stepson - John).
Relationship Name Age

 

1. What or who has led you to want to know more about the Catholic Faith?

2. Please describe the types of religious education you have received, as a child and as an adult?

3. What contact have you had with the Catholic Church to date?

4. What are some of the questions or concerns you have about the Catholic Church?

5. At this point in time, which of the following statements best describes your present feelings and thoughts about the     possibility of joining the Catholic Church? (please select one)
 A. I need much more information about the Catholic Church before I would consider joining.
 B. I am considering joining, but I am still unsure about it.
 C. I am fairly sure that I would like to join, but I still need some time to study and pray about it.
 D. I am fairly sure that I want to join the Catholic Church.


The Association for Catechumenal Ministry (ACM) grants the original purchaser (parish, local parochial institution, or individual) permission to reproduce and modify this form.      Updated 7/2010