Candidate Information

First Name *

Last Name *

Mobile Number *

Email *

Sex *

Select One

Male
Female
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Street Address *

City *

State *

Postal code *

Do you currently have a sponsor for Cursillo? *

Yes

No

Name of Parish and City *

Sacraments Received *

Baptism

First Communion

Confirmation

Check all that apply.

Date of Birth

Age *

Education Background *

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Elementary
High School
College
Post-Graduate
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Occupation / Business *

Marital Status *

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Single
Married
Divorced
Widowed
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Married by: *

Catholic Church

Civil

Spouse Full Name *

Spouse Religion *

Number of Children *

Has your spouse attended a Cursillo Weekend ? *

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Yes
No
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When did your Spouse attend a Cursillo?

Are they scheduled to attend a Cursillo Weekend? *

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Yes
No
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Do you have any condition that would required attention such as diet, medication or physical handicap? *

Yes

No

If yes, please explain.

Have you had a nervous breakdown? *

Yes

No

If yes, when?

In case of emergency, please notify: *

Emergency Mobile Number *

Has your sponsor answered all your questions and been available in your preparation for Cursillos? *

Yes

No

Please state why you wish to attend Cursillo? *

Sponsor Full Name *

Sponsor Mobile Number *

Sponsor Email *

Sponsor Parish *

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