Youth Encounter

(Virac Model)
Facilitators Seminar Workshop
April 24 26, 2015

REGISTRATION
FORM
PERSONAL DATA

__________________________________________ Nickname: ___________ Gender: Male Female

Surname (In Print) First Name (s) M.I.
Birthday: __________________ Birthplace: __________________ Age: __________
Mailing Address:
__________________________________________________________________________
Contact Number: ___________________________ E-mail Add: _________________________________
School: _____________________________________ Yr. & Course:
________________________________
Occupation (if working): _____________________ Place of Work:
______________________________

YOUTH MINISTRY INFORMATION

Parish/School/Center: ________________________________ Address:

____________________________ Rector / Parish Priest: ____________________________ Youth
In-charge: ______________________ Telephone / Fax Number: ________________________ E-mail
Add: ___________________________

YOUTH ENCOUNTER (Virac Model)

Basic Christian Formation Program for Youth

YE Batch Number: _________ Date: __________________ Place:

______________________________
Facilitator/s: _____________________________________________________________

Group/s in the Youth Ministry: Describe your involvement in the group:

Describe your part in the youth ministry of your school or parish:

Other Seminar(s)/ Formation(s) attended: