SANTA ROSA
PRE-CONFIRMATION REGISTRATION FORM 2023
INSTRUCTIONS:
✓ CANDIDATE MUST BE BORN BETWEEN 2010 AND 2012
✓ Registration Fee of $150.00 required.
✓ Registration Forms can be accessed on the Santa Rosa/Malabar Cluster website, filled out online and
submit to
[email protected] .
✓ Registration fees can be deposited in Republic Bank Arima, Santa Rosa Parish, A/C #460803521901.
✓ On the receipt state candidate’s name, copy and submit with completed form on designated day.
✓ Registration fees can also be paid when submitting completed form on designated day.
✓ THE REGISTRATION PROCESS WILL BE COMPLETED FACE TO FACE WITH PARENT AND CANDIDATE
PRESENT. Bring 1 copy each of Candidates Birth, Baptism, First Communion Certificates and a
passport size photo.
✓ Registration Completion Days:
Sat. 22 July, 2023 - 9:00am - 12:00noon Sat. 29 July, 2023 - 9:00am – 12:00noon.
✓ Venues for the above will be announced in due course. (Candidates will select their jersey SIZE on
these days.)
✓ REGISTRATION CLOSES ON SATURDAY 29TH JULY, 2023.
NOTE: Registration fees paid prior to Saturday 29th July (through Bank Deposit) without completing
the Registration Process on the designated dates will be REFUNDED.
Candidate’s Details:
J'velle Michela
First & Middle Names (only): _______________________________________________
Last Name:___________________________________________
Adams
Date of Birth: Year_______
2011 Month________
Sep Day________
10 Male☐ Female☐ X
Home Address: _____________________________________________________________________
9a El Carmen Street Arima
2012 Month________
Date of Baptism: Year_______ April 22
Day________ La Horquetta
Parish__________________
2021 Month________
Date of First Communion: Year_______ Feb 14th
Day________ Mount St Benedict
Parish__________________
Medical Concerns:
Allergies: Yes☐ No☐
X Asthma: Yes☐ No☐
X
Other:___________________________________________________________________
Where do you normally attend Mass:
X Malabar☐ Holy Cross☐ Pinto Rd.☐ Tumpuna Rd.☐ Valencia☐
Santa Rosa☐
Santa Rosa Heights☐ Aripo☐
As part of their Faith Formation, candidates are asked to participate in one of the following Liturgical
groups/Ministries in the cluster. Please tick to indicate which you are currently involved in or will become part
of.
Mass Usher☐ Altar Server☐ Lector☐ Mass Host☐ Church Choir☐ Soup Kitchen☐
St. Vincent De Paul☐ Refugees & Migrants☐ Meals on Wheels☐ Audio/Video Communication☐
Are you a member of:
Precious Blood Community Yes☐ No☐
X
People of Praise Community Yes☐ No☐
X
Nelicia Adams
Name of Parent/Guardian: ____________________________________________________
797-7080
Phone Contact: _____________________ [email protected]
Email Address: ______________________________
I certify that all the information given above is true and correct.
29th July 2023
DATE: _______________
X
(Signature of Parent/Guardian)
