General Information - R.C. Church of Our Saviour

Registration Form

Please send us your registration ( * = required)

Details of (family) adults

Last name *
First name *
Nationality
Occupation
Date of birth (dd-mm-yyyy) *	- -

Last name of partner
First name of partner / wife
Nationality
Occupation
Date of birth (dd-mm-yyyy)	- -

Residence

Streetname and housenumber *
Postcode and town / city *

Methods of contact

Telephone number
Mobile number
Fax number
Email address

Details of children

First names
Date of birth (dd-mm-yyyy)	- -
First names
Date of birth (dd-mm-yyyy)	- -
First names
Date of birth (dd-mm-yyyy)	- -
First names
Date of birth (dd-mm-yyyy)	- -

Please mention last name and or Nationality, if different from those of the first name of the form

Unless you particularly object here,	I Object
your name will be published in the parish directory

2002 © ESIRC - English Speaking International Roman Catholic Parish of The Hague

Parish House - Ruychrocklaan 126 - 2597 ES Den Haag
Tel. 070 - 328 0816