Please note:
This form is confidential and for internal use only.
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Weekend Number
First Name *
Last Name *
Middle Initial or type NONE *
Name Tag First Name *
Gender *
Male
Female
Are you
Age *
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Cell Phone Number *
Valid email address *
Contact from Pre-Cursillo will be forthcoming. Please pick your contact preference.
Note: whichever method you choose it is important to check often for correspondence.
 *
Text
Email
Contact me by:
*
Married
Single
Widowed
Are you
Number of Children and Ages:
Spouse's Name
Yes
No
Has your spouse attended Cursillo?
*
Employed
Retired
N/A
Are you
Former or current occupation: *
Please list any physical limitations, medical conditions, or anything else that may cause difficulty during your Cursillo weekend: *
Do you have any special dietary requirements or food allergies? *
Yes
No
Please answer
Vegetarian
Vegan
Gluten free
Dairy free
Tree nuts
Peanuts
Nuts (Airborne)
Please check all that apply:
If you have food allergies please elaborate:
Sponsor's Name
Sponsor's Cell Phone Number:
Sponsor's Email Address:
Yes
No
Has your sponsor told you about opportunities for spiritual growth beyond your Cursillo weekend?
*
Yes
No
Are you of the Catholic faith?
If yes, what Rite?
*
Yes
No
Are you baptized?
What is the name of your current parish and the city in which it is located? *
Please list any religious and/or professional organizations to which you belong:
How did you hear about Cursillo? *
Please state in your own words why you wish to live a Cursillo:
I understand that the Detroit Cursillo Movement is Catholic and is dedicated to Christian Motivation. I am willing to take part in the weekend knowing that it consists of 3 days and 3 nights and that my continuous presence is required. I expressly waive all claims against the Detroit Cursillo Movement, or their representatives, on account of any accidents, injury, illness, or other damage that may occur in connection with or incidental to my attendance on the weekend. (Please initial below) *
Emergency Contact Name: *
Emergency Contact Cell Number: *
List of Prescription Medications for Emergency Use Only: *
Full donation amount or deposit is due when submitting application and can be done online or by mail. If you submit a deposit the balance is due at Thursday night check-in. Donation instructions are found at https://cursillodetroit.com/forms/ 
If you have any questions please contact your sponsor or our Pre-Cursillo Coordinator Chris Wesley at (248) 877-1855
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Deposit
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