Parish Census Survey

Please list the names of the primary members of your household:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth Please enter a date.
First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
What is the marital status of primary members: Married Separated/Divorced Widowed

Please list the names of others who live in your household:

First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
Relationship to primary members:
First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
Relationship to primary members:
First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
Relationship to primary members:
First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
Relationship to primary members:
First Name Please enter valid data.

Last Name Please enter valid data.
Date of Birth Please enter a date.
Relationship to primary members:
If there are additional people living in your household, please list their names, dates of birth, and relationships to you here:

Street Address REQUIRED Please fill out this field. Please enter valid data.

Mailing Address (If Different) 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.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Secondary Email Please enter an email address.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Primary Mobile Phone Number Please enter a phone number.

Secondary Mobile Phone Number Please enter a phone number.

Which Church in the Parish do you normally attend: Holy Martyrs in Falmouth Sacred Heart in Yarmouth St. Gregory in Gray St. Jude in Freeport

What is your preferred mass time: Please enter valid data.

During the COVID Pandemic have you been watching the parish's live-streamed masses? REQUIRED Yes No I didn't know about the live-streamed masses I would like help learning how to watch the live-streamed mass Please fill out this field.

Now that we are able to celebrate in-person masses, have you signed up to attend a mass? REQUIRED Yes No, but I would like more information or assistance signing up No, I am not ready yet due to personal or health reasons Please fill out this field.

We send out the weekly bulletin, messages from the pastor, and other news by email through POTHEnote. Are you receiving these? REQUIRED Yes No -- I would like to No -- I signed up but am not receiving the messages No -- I am not interested and can get information I want from the website or other ways Please fill out this field.

Which is the best way to contact you with info about mass, parish news, and events: Phone Email Text Flocknote / POTHEnote

Do you feel the parish is communicating news and information well? Yes No

Is there anything the parish is not offering that you feel could benefit you or other parishioners? If so, please describe:

Please list any comments or information you think might be helpful as the parish moves through the phases of reopening:

Parish of the Holy Eucharist

Falmouth, Freeport, Gray & Yarmouth, ME

Parish Census Survey