Name:
Mailing Address
City, State and Zip:
Email Address:
Home Phone #:
Date of Birth:
(Month) January February March April May June July August September October November December (Day) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19 (year) 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 Earlier
Parent's Name:
Parent's Phone:
Parent's Address:
Parent's City, State and Zip:
College of Attendance:
Clarkson University St. Lawrence University SUNY Canton SUNY Potsdam
Year in Attendance:
Freshman Sophomore Junior SeniorGrad Student
Please check the corresponding box indicating the way you wish to share your time and talent with our faith community.
Sacramental Preparation: I am interested in...
Becoming Catholic
First Communion
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Being Confirmed
Liturgical Involvement
Communion Minister
Art & Environment
Reader
Musician/Choir
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Instrument
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Information about Religious Vocations
Bible Study/Faith formation
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I am interested in learning more about
Alternative Spring Break
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