&lt;div&gt; Become part of our family!&lt;/div&gt;

Head of Household

Date REQUIRED Please fill out this field. Please enter a date.
Family Last Name REQUIRED Please fill out this field. Please enter valid data.
Parent Name Please enter valid data.
Email Please enter an email address.
Phone Number Maximum 20 characters Please enter a phone number.
Parent Name Please enter valid data.
Email Please enter an email address.
Phone Number Maximum 20 characters Please enter a phone number.
Street Address Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Marital Status

Tithing method desired REQUIRED Please fill out this field.

May we include all provided information in the church directory? REQUIRED Please fill out this field.

May we publish photos of you and your family on social media accounts and any publications? REQUIRED Please fill out this field.

Are you a Valparaiso University student? REQUIRED Yes No Please fill out this field.

In case of emergency, please contact: (List name and number) Please enter valid data.

Why did you choose St. Teresa of Avila Catholic Student Center?

Total number of family members REQUIRED Please fill out this field.
Family Member 1
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 2
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 3
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 4
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 5
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 6
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 7
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.
Family Member 8
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Sacraments Received
- Occupation/School Grade Level Please enter valid data.

Check out our Ministries Opportunities at St. Teresa of Avila