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                  BUKAS-LOOB SA DIYOS COVENANT COMMUNITY
                                         Phoenix, Arizona

                            PERSONAL INFORMATION SHEET
                   YOUTH LIFE IN THE SPIRIT SEMINAR #3
                                   November 6-8, 2009


Part I: Basic Information-Candidate

Last Name:                       First Name:                        Nickname:


Street Address:                  City:                              State/Zip Code


Home Telephone:                  E-mail Address:                    Screen Name:


Date of Birth (Mo/Day/Yr)        Age/Sex: (Must be 14-20 yrs old)   BLD Affiliation #/Location:
                                                                    YE____ YLSS____

Current Parish:                  Town/City:                         Parish Priest/Pastor:


  Holy Sacraments Received:                  Baptism:                         Confirmation:
                                           Yes___ No___                       Yes___ No___



Part II: Additional Information-Parents
Father’s Name:                                       BLD Affiliation:

                                                     ME___ FE___
Mother’s Name:                                       LSS___ SPE____


Signature: Candidate            Date:              Signature: Parents/Guardian                Date:

__________________              _______            _________________________                  ______

Contact Persons                                                 Venue:
Manny & May Siongco (480) 857-4972                              Lake Pleasant Desert Outdoor Center
Crosby & Marissa Cortez (732) 547-1423                          41402 N. 87th Ave. Peoria, AZ 85383
Louise Lazaro (206) 579-1573                                    Peoria, AZ 85383
Bushen Rivera (602) 432-4956
Ylss#3 Application

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Ylss#3 Application

  • 1. Confidential Please Print Clearly BUKAS-LOOB SA DIYOS COVENANT COMMUNITY Phoenix, Arizona PERSONAL INFORMATION SHEET YOUTH LIFE IN THE SPIRIT SEMINAR #3 November 6-8, 2009 Part I: Basic Information-Candidate Last Name: First Name: Nickname: Street Address: City: State/Zip Code Home Telephone: E-mail Address: Screen Name: Date of Birth (Mo/Day/Yr) Age/Sex: (Must be 14-20 yrs old) BLD Affiliation #/Location: YE____ YLSS____ Current Parish: Town/City: Parish Priest/Pastor: Holy Sacraments Received: Baptism: Confirmation: Yes___ No___ Yes___ No___ Part II: Additional Information-Parents Father’s Name: BLD Affiliation: ME___ FE___ Mother’s Name: LSS___ SPE____ Signature: Candidate Date: Signature: Parents/Guardian Date: __________________ _______ _________________________ ______ Contact Persons Venue: Manny & May Siongco (480) 857-4972 Lake Pleasant Desert Outdoor Center Crosby & Marissa Cortez (732) 547-1423 41402 N. 87th Ave. Peoria, AZ 85383 Louise Lazaro (206) 579-1573 Peoria, AZ 85383 Bushen Rivera (602) 432-4956