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Registration

We are happy to welcome you to the Crozet Catholic Community at Our Lady of the Rosary. Please complete the form below. Information will be submitted directly to our Parish Administrative Assistant, Marianne Jackson. Note that all families wishing to enroll children in our Christian Formation Program must first be registered with the Parish by completing this form.

Please contact Marianne at (434) 812-2936 with any questions.
Parish REGISTRATION FORM
The maximum number of form submissions has been reached. This form is currently not available.
- Head of Household:
- Title Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Home Phone Number Please enter a phone number.
- Mobile Phone Number Please enter a phone number.
- Work Phone Number Please enter a phone number.
- Which is your preferred phone number? Home Mobile Work
- Were you previously registered with or currently active in another parish in the Richmond Diocese?
- Other Parish Name and Location:
  Example: St. Thomas Aquinas, Charlottesville VA
  Please enter valid data.
- Sacraments Received REQUIRED
  Please check all that apply
  Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
- I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
- Primary Language Please enter valid data.
- Occupation (if applicable) Please enter valid data.
- How would you like to be involved? What ministries are you interested in?
- Please enter the number of other people who are presently residing in your home or temporarily away at college or military duty.
- Other Family Members REQUIRED
  How many other people are in your household?
  Please fill out this field.
  
  Family Member 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
  
  Family Member 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Relationship to Head of Household REQUIRED Spouse Child Other Please fill out this field.
  
  Email Please enter an email address.
  
  Phone Number Please enter a phone number.
  
  Sacraments Received REQUIRED Baptism Communion Confirmation Catholic Marriage (Other Marriage) None Please fill out this field.
  
  I identify my ethnicity as:
  Select all that apply
  Asian Black/African American White/Caucasian Hispanic/Latino Native American Pacific Islander Prefer Not to Answer
  
  School Name (if applicable) Please enter valid data.
  
  School Grade (if applicable) Please enter valid data.
  
  Occupation (if applicable) Please enter valid data.
  
  Primary Language Please enter valid data.
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