OCIA Registration

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Name

First

Middle

Last

Maiden Name (if applicable)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Date of Birth

Place of Birth

Occupation

Present religious affiliation (if any)

Have you ever been baptized?

What is your current marital status?

Father's Name

First

Last

Father's religious affiliation (if any)

Mother's Name

First

Last

Mother's religious affiliation (if any)

Number of children (if any)

Saturday: 5 pm
Sunday: 8:30 am & 11 am

Mon, Tues, Thur, Fri: 8.30 am
Wednesday: 7 pm (With the Novena to Our Lady of the Miraculous Medal)

11665 Fort Caroline Road
Jacksonville, Florida 32225

904-641-7244

Mon – Fri:
9am – 4:30pm