St. Theresa Catholic Church

Henniker, New Hampshire

R.C.I.A.

I am interested in the R.C.I.A.  Please add my name to the list for the registration mailing.

Name:______________________________________________________________

Daytime Phone:______________________________________________________

Home Phone:________________________________________________________

Mailing Address:_____________________________________________________

                                                    (street)

___________________________________________________________________

   (PO Box)                                      (City)                        (Zip)

Baptized    (Circle)                  Yes                         No

If Yes, in what Faith?_________________________________________________

Please mail completed form to St. Theresa Parish, PO Box 729, Henniker, NH 03242-0729.