Registration Form

Catholic Campus Ministry at Christopher Newport University

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Registration 2011-2012

Name *

First

Last

Date of Birth *

Month/Day/Year 01/02/1990

Academic Year *

Graduation Year *

Intended Major *

Cell Number *

Email *

We will add you to CCM's Email List!

Permanent Address *

Line 1

Line 2

City

State

Zip Code

Country

Local Address *

Please include DSU Mailbox # if you live on campus.

Residence Hall/Room# *

If you don't live on campus, please leave this space blank.

Home Parish *

Line 1

Line 2

City

State

Zip Code

Country

Sacramental Information

Baptized Catholic? *

Yes No

First Eucharist? *

Yes No

First Reconciliation? *

Yes No

Confirmation? *

Yes No

If No? Baptized in another denomination? *

Yes No

Denomination? *

If you answered “No” to any of these questions, and would like to learn about the process required to participate in these sacraments, please check below: *

I am interested

Family Information

Father's Name *

Phone Number *

Email *

Address (if different than yours) *

Mother's Name *

Phone Number *

Email *

Address (if different than yours) *

There are many ways of becoming involved in Catholic Campus Ministry at CNU. Please mark the areas that interest you.

See something below but aren't yet sure what it means? Check it anyways! We'll be happy to send you more information.

Liturgical Ministries

Choose Any *

Alter Server Eucharistic Minister Lector Hospitality (Welcome Usher) Music Ministry

If interested in music, please designate vocal and/or instrument you play. *

Spiritual

Choose Any *

Scripture Study Renewal Prayer Group Reconciliation Viaticus Beach Retreat for FRESHMEN Encounter With Christ, Diocese of Richmond College Student Retreat Adoration

Education

Choose Any *

Help with a Twilight Retreat Teach CCD at parish Assist Teacher at parish school Help with youth ministry at local parish Confirmation/RCIA/CHICA sponser

Communications/Publicity

Choose Any *

Make/Hang CCM Flyers/Posters Help maintain database Assist with website updates

Justice/Peace

Choose Any *

St Paul's Outreach (serve inner city poor) Breathe (help with special needs parish children) Alternative Spring Break Legislative Action March for Life Organize campus collections for disaster relief/ Heifer International/Catholic Relief Services/etc. Hunger Banquet Organize fundraiser/drive for Food Bank Relay for Life Community Outreach PB and J Sandwiches for distribution to downtown neighbors

Fellowship

Choose Any *

Help with Cathletics Organize CCM's semi-formal Help with CCM's socials Help with Community Dinners

Stewardship

Choose Any *

Help with Sign Ups for Ministries/Events Help with T-shirt sales Help Encourage Participation/Giving Help with fundraising events

I have read through all the above ways to get involved *

Yes

If you have a new CCM program or activity to suggest, please mention it below and submit your idea to our Leadership Team.

Submit

How did you like using this form? Did you run into any problems? Do you have an idea for a new CCM program? Please let us know! If you would like a response, please fill in your personal information, otherwise you can leave it anonymous.

Name *

First

Last

You only need to submit this form if you have a comment.

Email *

Comment *

You only need to submit this form if you have a comment.

Submit