Facebook Flocknote

Online Request for Quinceanera

- Ministries

The maximum number of form submissions has been reached. This form is currently not available.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- Are you a registered parishioner of St. Justin Martyr Parish? Yes No
- Date Requested for the Quinceanera REQUIRED Please fill out this field. Please enter a date.
- Venue and Fees REQUIRED Chapel 2:00pm $400 ($100 non-refundable deposit. $300 balance payable a month before the event.) Church 2:00pm $800 ($200 non-refundable deposit. $600 balance payable a month before the event.) Please fill out this field.
- PARENT'S NAME (either the mother or father) 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.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Quinceanera Information
  
  Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Birthday: REQUIRED Please fill out this field. Please enter valid data.
  
  Baptized? Yes Date Baptized_________________________________
  
  1st Commnunion? Yes Date of 1st Communion_________________________
  
  In CCE now?_________________ Where? Please enter valid data.
Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.