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Cursillo Weekend Application

Use this form to submit an application for a Cursillo Weekend.
 
  Name  First   Init.   Last
 
  Gender
  Birth Date (YYYY MM DD)
  Occupation
  Marital Status
 
  Are you canonically eligible to receive the Sacraments?
  Are you Roman Catholic?
  If you are not Catholic, enter your Denomination or NA.
  Parish
 
Address
   
  City
  Province
  State
  Country
  Postal Code   Canada Format: X9X9X9
  Daytime Phone  Ext.  Format: 999 999 9999
  Evening Phone   Format: 999 999 9999
  Cell Phone   Format: 999 999 9999
  Email Address
  Reenter Email
  ** If the candidate doesn't have an email address, please use your email address instead.
 
  Impairments requiring assistance, accommodation, or special consideration:
  Special dietary requirements:


Other dietary/allergy requirements not listed above:
  Do you have any physical/mental health, addiciton, emotional or other conditions
we should be aware of:



Please elaborate if you have listed any of the conditions above:
 
  Emergency Contact Information
  Name  First   Init.   Last
  Relationship
  Daytime Phone  Ext.  Format: 999 999 9999
  Evening Phone   Format: 999 999 9999
  Cell Phone   Format: 999 999 9999
 
  Sponsor Information
  Name     
  Email Address
 
 
  Enter any comments or additional information (including hobbies) here...
 
  ** Please enter colores before submitting the form.

 
 
      
 

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