Centro Católico Carismático Hispano
826 east 166th street Bronx N.Y. 10459
Tel: 718-378-1734 Fax: 718-378-1819
826 east 166th street Bronx N.Y. 10459
Tel: 718-378-1734 Fax: 718-378-1819
Retiro de Formacion para Adultos
Fecha:___/____/_____
Date:
Date:
Etapa:_________________
Phase::
Phase::
Nombre:_________________
Name:
Name:
Fecha de Nacimiento:___/____/____
Date of Birth :
Date of Birth :
Apellido:_________________
Last Name:
Last Name:
Direccion:_____________________________
Address:
Address:
Ciudad:_________________
City:
City:
Estado:___________
state:
state:
Codigo Postal:_______
Zip Code:
Zip Code:
Apt #:______
Sexo:
Gender:
Gender:
Email:__________________________________
Bautizado:______
Baptized:
Baptized:
Primera Comunion:______
First Comunion:
First Comunion:
Telefono:_________________
Phone:
Phone:
Tienes algun problema de Salud:_____________________________________________________
Do you have any health problems?:
Do you have any health problems?:
Estado Social: Soltero (a) O Casado (a) O Divorciado (a) O
Marital status: Single Married Divorced
Marital status: Single Married Divorced
Casado por : Iglesia catolica O Civil u otra iglesia O Viven en union libre O
Married by: Catholic Church Civil or other church Just living together
Married by: Catholic Church Civil or other church Just living together
Perteneces a alguna Parroquia?
Are you member of a parish?
Are you member of a parish?
SI O
No O
No O
SI O
No O
No O
Nombre de la Parroquia?_____________________
Name of the Parish?
Name of the Parish?
Perteneces a algun grupo en la Parroquia?
Are you member of a Group in the Parish?
Are you member of a Group in the Parish?
Nombre del grupo?____________________
Name of the group?
Name of the group?
Retret you have already done :
Fecha del retiro que desea Asistir :___/____/_____
Retret's Date you want to asist::
Retret's Date you want to asist::
SI O
No O
No O
SI O
No O
No O
| Por favor lea esto antes de firmar Favor de no traer cosas de valor, ni prenda de ninguna clase. No somos responsables de valores perdidos. Prometo permanecer estos tres dias de retiro obedeciendo las reglas de disciplinas y mantener limpio el local y atencion a las conferencias. |
| Please read this before sign. Do not bring any valuables nor jewelry of any kind. We would not be responsible for any lost. I promise to stay these three days on the retreat, obey the rules, discipline, keep clean the rooms, and attend the conferences |
Firma:_________________
Sign:
Sign:
M O
F O
F O
