2016-2017 Student Parishioner Registration Form
Each year, we ask students to register (and re-register!) as members of the University Parish Newman Center to help us serve you better! Please note: this year we are combining the registration form with the ministry commitment form. This means that you can sign up for liturgical ministries immediately without waiting until September.

Thank you for your presence and participation in the life of your parish community!

If you have questions about this form, please contact Mary Lynn Delfino at mdelfino@kent.edu.

Personal Information
First Name
Your answer
Last Name
Your answer
Phone Number
Enter your phone number using this format: XXX-XXX-XXXX
Your answer
Text Messaging
I give permission for Newman Center staff and/or CSA leaders to send occasional text messages at this number.
E-Mail Address
Your kent.edu address is preferred.
Your answer
Class of
Year
Major
Your answer
Birthdate
MM/DD/YYYY
Your answer
Gender
Campus/Local Address
Street Address
If living in a residence hall, type the name of your residence hall here (Example: Johnson Hall, KSU)
Your answer
Street Address 2
If living in a residence hall, type the street address of your residence hall (Example: 375 Janik Dr.)
Your answer
City
Your answer
State
Please use standard state abbreviations (e.g. OH, PA, MI, NY, etc.)
Your answer
Zip Code
Your answer
Parent(s) Information
For U.S. students only. International students need not complete this section.
Parent(s) First Name
Your answer
Parent(s) Last Name
Your answer
Street Address
Your answer
Street Address 2
Your answer
City
Your answer
State
Please use standard state abbreviations (e.g. OH, PA, MI, NY, etc.)
Your answer
Zip Code
Your answer
Phone Number
Enter your parent's phone number using this format: XXX-XXX-XXXX
Your answer
Parent(s) E-Mail Address
Your answer
Sacramental Information
Check the following status that best describes you.
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