CURSILLO REGISTRATION - CURSILLO IN THE ARCHDIOCESE OF TORONTO

CURSILLO WEEKEND

Please Chose Your Cursillo Weekend

CANDIDATE INFORMATION

Name

First

Middle

Last

Birth Date

Gender

Female
Male

Occupation

Marital Status

Married
Single
Divorced
Separated

Address Line 1

Street Address including Unit/Apt Number if applicable

Address Line 2

CIty

Country

Postal/Zip Code

Other Country

If you chose Other for Country, please specify

Business/Home No.

Mobile No.

Email Address

Religious Affiliation

Cathoric
Protestant/Non-Denimonational
Other

If you chose Other for Religious Affiliation, please elaborate

Parish/Church

Please enter the name of your Parish and/or the Church you attend

Are you eligible to receive Holy Sacraments?

Yes
No

Disabilities or other impediments (Physical, Pshycological, Addictions, etc.)

No
Yes

Please List any DIsabilities or Other Impediments (Physical, Pshycological, Addictions, etc.)

Please enter any information pertaining to any disabilities, health or mental problems/issues or any other conditions such as emotional problems, addictions, etc. we should be aware of.

NOTE: Such information will be maintianed in the strictest confidence.

PLEASE NOTE: If you rather speak to someone about any disabilities or other impediments, please click Yes to the question “Do you want someone to contact you regarding this application?” in the OTHER APPLICATION INFORMATION Section below.

Do you have any food allergies or other dIetary requirements?

No
Yes

Please List any Food Allergies or Dietary Requirements

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

First

Middle

Last

Emergency Business/Home No.

Emergency Mobile No.

Emergency Contact Relationship

Spouse
Other Family Relation
Friend

Emergency Contact Reltionship

SPONSOR INFORMATION

Sponsor Name

First

Middle

Last

Sponsor Email (if known)

OTHER APPLICATION INFORMATION

Will you require a ride to the Cursillo Venue

No
Yes

Assistance with ride to the Venue

Do you want someone to contact you regarding this application?

No
Yes

Please Contact me regarding this registration

Comments/Additional Information

INFORMATION Allergies Venue

Terms and Conditions

I agree to the terms and conditions of participating in a Cursillo Weekend

TERMS & CONDITIONS

All information entered on this form will be kept in the strictest confidence and will not be shared with anyone outside of the Cursillo Movement in the Archdiocese of Toronto. All candidate information is for the sole purpose of organizing and conducting the Cursillo Weekend. Following the Cursillo Weekend, all information that is no longer relevant to membership is deleted from our systems and records.

I agree that I will not under any circumstances share the names of other Cursillo participants, leaders and organizers or any information about the discussions, contents and structure of the Cursillo with anyone outside of the Cursillo movement except when legally required to do so.

Date / Time of Registration

Date

Time

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