Student Registration

Contact Information Student Name 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 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)

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Student Registration