Worshipping Community Membership Registration Form First Name * Last Name * Phone Number * E-mail Address * Street Address * City * Postal Code * When did you first begin attending mass with us? * Year Year19791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Which mass do you typically attend? * 9:30 a.m. 11:30 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. Would you like to add information for a second adult? * Yes No Second Adult First Name * Last Name * Phone Number * E-mail Address * When did you first begin attending mass with us? * Year Year19791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Which mass do you typically attend? * 9:30 a.m. 11:30 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. Would you like to add information for children under 18? (Children over the age of 18 living in the same household are asked to fill out their own membership form). * Yes No Child 1 Child's First Name Child's Last Name Child's Birthdate Year Year20002001200220032004200520062007200820092010201120122013201420152016201720182019 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 Year20002001200220032004200520062007200820092010201120122013201420152016201720182019 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 Year20002001200220032004200520062007200820092010201120122013201420152016201720182019 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 Year20002001200220032004200520062007200820092010201120122013201420152016201720182019 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 Year20002001200220032004200520062007200820092010201120122013201420152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 My child has already received the following sacraments. Baptism First Communion Confirmation None Submit
