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Catholic Community in Central Racine. RCIA Registration Form 2020-2021 * RICA Forma de Inscripción para Adultos
(Sacraments for Adults over 18 years old after High School/Mayores de 18 que ya hayan salido de High School)
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* Indicates required question
Email
*
Your email
WHAT PARISH DO YOU BELONG TO? / A QUE PARROQUIA PERTENECES?
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ST. PATRICK
ST. EDWARD
ST. RICHARD
Other:
IS YOUR FAMILY REGISTERED AS A PARISH MEMBER? / ESTA SU FAMILIA REGISTRADA EN LA PARROQUIA?
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Yes
No
LAST NAME / APELLIDO
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Your answer
FIRST NAME / PRIMER NOMBRE
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Your answer
ADDRESS / DIRECCIÓN
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Your answer
CITY / CIUDAD
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Your answer
STATE / ESTADO
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Your answer
ZIP CODE / CODIGO POSTAL
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Your answer
DATE OF BIRTH / FECHA DE NACIMIENTO
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MM
/
DD
/
YYYY
AGE / EDAD
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Your answer
HOME PHONE / TELEFONO CASA
Your answer
CELL PHONE / NÚMERO DE CELULAR
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Your answer
WHAT IS YOUR PRIMARY LANGUAGE? (CHECK ALL THAT APPLY) / QUE IDIOMA ENTIENDE USTED? (SELECCIONE TODAS LAS QUE APLIQUE)
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ENGLISH / INGLES
SPANISH / ESPA
BOTH / AMBOS
Required
DOES THE PARTICIPANT REQUIRE ANY OTHER SPECIAL ACCOMMODATIONS? / TIENE EL PARTICIPANTE ALGUNA NECESIDAD ESPECIAL?
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Yes
No
IF YES, PLEASE LIST WHAT ACCOMMODATIONS THEY NEED / POR FAVOR EXPLIQUE SI REQUIERE DE AYUDA ESPECIAL Y DE QUE TIPO
Your answer
WHAT DAY DURING THE WEEK WORKS BEST FOR CLASSES? PLEASE INCLUDE DAY AND TIME, EXAMPLE: Monday after 5pm / QUE DIA DURANTE LA SEMANA ES MEJOR PARA LAS CLASES? POR FAVOR INCLUYE DIA Y HORA, EJEMPLO: Lunes después de 5pm.
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Your answer
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