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Catholic Newman Community Registration
Contact Information
Name:
*
First Name
Last Name
Address:
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email:
*
Verify Email
*
Mobile Phone:
###-###-####
Birthdate:
(mm/dd/yyyy)
Academic Information
May we occasionally text you?
Yes
No
Are you an international student?
Yes
No
What is your country of origin?
Affiliation:
*
select one
Parent
Student
Other
Class Year:
Major(s):
Minor(s):
Specialty(ies)/Graduate Program(s):
Department:
If other, please explain.
Activities/Interests
Adoration
Altar Serving
Would like to receive Confirmation
Communion Ministering
Lector
Music Ministry/Choir
Reconciliation/Confession
Retreats
Service Opportunities
Social Events
If other, please explain.
Parent Contact Information
Only fill out this section if you are an undergraduate student.
Parent/Guardian #1 Name:
First Name
Last Name
Is your first parent/guardian's address the same as yours?
Only fill out the below address form if your first parent/guardian's address is different from yours.
Yes
No
Parent/Guardian #1 Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Parent/Guardian #1 Email:
Verify Email
Parent/Guardian #1 Mobile Phone:
Parent/Guardian #2 Name:
First Name
Last Name
Is your second parent/guardian's address the same as yours?
Only fill out the below address form if your second parent/guardian's address is different from yours.
Yes
No
Parent/Guardian #2 Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Parent/Guardian #2 Email:
Verify Email
Parent/Guardian #2 Mobile Phone:
Home Parish Information
Only fill out this section if you are an undergraduate student. Please fill in as much information as you know.
Parish Name:
Pastor/Pastoral Administrator's Name:
First Name
Last Name
Parish Address:
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country