Forms

Application Date

- Month - Day at Year / Hour Minutes

I Am Applying For:

Men's Weekend Women's Weekend

Full Name*

First Name Middle Name Last Name

Please indicate your name as you would like it shown on your name badge*

Address*

E-mail*

Phone Number*

- Area Code Phone Number

Alternate Phone Number*

- Area Code Phone Number

Parish

Emergency Contact Name*

First Name Last Name

Emergency Contact Phone Number*

- Area Code Phone Number

Has your spouse completed a Cursillo Weekend

Yes No

Please indicate any physical limitations

Please indicate any health issues

Marital Status*

Age Group*

Catholic*

Yes Other

If Other, please specify*

Would you be able to attend on short notice?*

Yes No

Do you have a Sponsor*

Yes No

Sponsor 's Name

Sponsor 's Relationship

Sponsor's eMail

Sponsor's Phone Number

- Area Code Phone Number

Sponsor's Parish

Ottawa Cursillo Movement