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New Parishioner Registration

- About QHR Wea

Welcome to QHR-Wea! We're happy you're here! Please complete the following registration form. If you have any questions, comments or additional information you'd like to provide, please feel free to reach out to the parish office at [email protected] or (913) 533-2464.
New Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- Head of Household (HH)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Home Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Number (if different) Maximum 20 characters Please enter a phone number.
- Street Address of Household Residence 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.
- Mailing Address (if different than street address) Please enter valid data.
- Gender
- Marital Status REQUIRED Please fill out this field.
- Catholic? REQUIRED Please fill out this field.
- Home Bound
- Special Needs
- Date of Birth (MM/DD/YYYY) REQUIRED Please fill out this field. Please enter a date.
- Were you previously registered at another parish? REQUIRED Please fill out this field.
- If yes, which parish? Please enter valid data.
- Are you considering enrolling a child at QHR-Wea school or preschool? REQUIRED Please fill out this field.
- Does someone in the household need any of the following? Check all that apply. REQUIRED Baptism First Eucharistic / Confirmation Marriage Prep RCIA Annulment N/A - none required Please fill out this field.
- Parish Support Preference REQUIRED Offering Envelope Electronic Giving Please fill out this field.
- Would you like to be contacted by any of the following? Altar Society Christian Family Movement Homeschool Group Knights of Columbus Men's Club Rosary Guild Wea Quilters Wea Young Families
- Head of Household's Talents Offered
- Would you like a personal visit from the pastor? REQUIRED Please fill out this field.
- Are you considering enrolling a child in School of Religion? REQUIRED Please fill out this field.
- Other Household Members
- Number of Other Household Members REQUIRED
  Select the number of other household members (to include spouse, child/children or other) and provide the additional information requested.
  Please fill out this field.
  
  Other Household Member 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 5
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 6
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 7
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 8
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 9
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 10
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 11
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 12
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 13
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 14
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
  
  Other Household Member 15
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relationship to HH Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Gender
  
  Marital Status
  
  Catholic?
  
  Homebound
  
  Special Needs
  
  Date of Birth (MM/DD/YYYY) Please enter a date.
  
  Student?
  
  If yes, check all that apply: Student - Angel House (childcare) Student - QHR-Wea School Student - School of Religion Student - Home School Student - Catholic HS Student - Public HS Student - College
  
  Talents Offered
Submit

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Queen of the Holy Rosary - Wea	Parish	School
22779 Metcalf Rd.	p. (913) 533-2464	p. (913) 533-2462
Bucyrus, KS 66013	e. [email protected]	e. [email protected]

New Parishioner Registration

Head of Household (HH)

Other Household Members