Second Adult

First Name *

Last Name *

Phone Number *

E-mail Address *

When did you first begin attending mass with us? *

Year Year19821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Which mass do you typically attend? *

10:30 a.m.

7:00 p.m.

How are you connected to the community? (Please check all that apply) *

St. Jerome's/UW university staff

St. Jerome's/UW university faculty

St. Jerome's graduate

UW graduate

Current St. Jerome's/UW student

From the Broader Community

Other

Other (please specify)

Are you currently a worshipping community volunteer (lector, eucharistic minister, choir member etc.) *

Yes

No

Which volunteer positions are you currently involved in? *

Mass Coordinator

Lector

Eucharistic Minister

Sacristan

Choir Member

Other

Other (please specify)

How would you like St. Jerome's Campus Ministry to communicate with you? *

I would like to receive communications from Campus Ministry (weekly e-bulletin which includes events, parking information, mass changes etc.).

I would like to receive communications from St. Jerome’s University about special events.

I do not want to receive any communications from Campus Ministry or St. Jerome’s University.

Child 1

Child's First Name

Child's Last Name

Child's Birthdate

Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

My child has already received the following sacraments.

Baptism

First Communion

Confirmation

None

Child 2

Child's First Name

Child's Last Name

Child's Birthdate

Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

My child has already received the following sacraments.

Baptism

First Communion

Confirmation

None

Child 3

Child's First Name

Child's Last Name

Child's Birthdate

Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

My child has already received the following sacraments.

Baptism

First Communion

Confirmation

None

Child 4

Child's First Name

Child's Last Name

Child's Birthdate

Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

My child has already received the following sacraments.

Baptism

First Communion

Confirmation

None

Child 5

Child's First Name

Child's Last Name

Child's Birthdate

Year Year20032004200520062007200820092010201120122013201420152016201720182019202020212022

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

My child has already received the following sacraments.

Baptism

First Communion

Confirmation

None