In order for you to receive the Ephpheta Centre’s Newsletter and other information about what is happening in the community we need to collect some information from you.
All the information we receive is considered confidential and at no point will it be used for anything other than for the purposes of the Ephpheta Centre.
We will not give your details to anyone unless we have your permission.
Some information is optional; you may choose not to answer some of our questions.
You will see an asterisk * next to some details. These questions must be answered for us to be able to send you our newsletter and/or keep you on our database.
If you have any questions in regards to this form please contact us and we will be happy to answer your questions. If you prefer to mail or fax the subscription form to us, download the form here.
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Address: |
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You are: |
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Mode of communication you prefer to use: |
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If you are married or have a defacto partner: |
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Please state what religious denomination you and your family belong to: |
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I have received: |
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Your partner: |
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Your children: |
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I/We would like more information about the Catholic religion |
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I/We would like our child/children to receive the following sacrament(s): |
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Baptism
First Communion
Confirmation |
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I would like to receive the Ephpheta Centre's newsletter in the post: |
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I would like to be contacted by email with extra information that is happening in |
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the community |
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Next of kin: |
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In the case of emergency, we have found it useful to be able to have contact details of a next of kin living outside of your family home. If you are happy to share these details we will of course keep them confidential and only use them in the case of a serious emergency. |
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Next of kin name: |
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Contact Number: |
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Relationship to you: |
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Any Comments: |
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If you have any comments or if you have more than five children, please enter their details in the text box below: |
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