Student Registration

Contact Information

Student Name Student ID Dorm/Local Phone E-mail

Local Contact

Address City, State, Zip

Permanent Contact

Address City, State, Zip

Student Information

Graduation Year Date of Birth (MM/DD/YYYY) Gender Male Female Religion I have been baptized. I have had my 1st communion. I have been confirmed.

Emergency Contact Information

Father

Name Address City, State, Zip Phone

Mother

Name Address City, State, Zip Phone

Faith Enrichment Opportunities

Are you interested in information of any of the following opportunities? Please check your interests.

Becoming Catholic/Confirmation Choir Lectors Hospitality Retreats Prayer Groups/Bible Study Cross Bearer Gift Bearers Decorating the Chapel (seasonally) Altar Server World Youth Day Vocations (Priesthood/Religious Life)

Social Justice/Service Opportunities

CROP WALK Salvation Army Dinners Habitat for Humanity Activities for Young Children Pennies from Heaven Students for Life COTS WALK (homeless shelter) Dismas House Dinners Visiting the Elderly Points for the Poor Clean up Days @ Catholic Center Office Help Other (please specify)

Social Opportunities

Catholic Center Dinners/BBQ Day Away Trips Movies at the Center Coffeehouse Entertaining Outdoor Events (Hiking, Biking, Skiing) Decorating for parties & shows Other (please specify)

By filling out this registration form, you will also be added as a member of the CSA (Catholic Student Association)