Registration Form

Queen of Peace Regional 2022-2024 Spiritual Assistant Class Registration Form

Please print:
Today’s Date ___________________  Date of Birth ___________________

Legal Name _____________________________________________________________

Address _____________________________________________________________

City ________________________     State _________   Zip __________

Home phone ________________  Cell phone _______________________

Email _____________________________________________________________

Member of which branch of the Franciscan Family or religious affiliation?
_____ OFM    _____ OFM Cap.     _____ OFM Conv.    _____ Poor Clare
_____ TOR     _____ Other Franciscan religious (please specify which community)  ___________________________________________________
_____ Diocesan Priest    _____ Diocesan Deacon  _____ Secular Franciscan

If you are a member of the Secular Franciscan Order, please answer the following:
            Local fraternity _________________________________________
            Local minister  __________________________________________
            Local Spiritual Assistant __________________________________
            Friar Province your local fraternity is bonded to_______________
            ____________________________________________

Why do you feel you are being called to serve as a Spiritual Assistant?
____________________________________________________________
____________________________________________________________
____________________________________________________________

How are you a servant leader at this present time?
____________________________________________________________
____________________________________________________________
____________________________________________________________

Signature ________________________________________________________