IVCF Bicol Regional Unit

DLTC 2k14 HAPPY FEET Registration Form

Name:__________________________________ School:_______________
Course & Year level:_________________ Age:____ Sex:___ Birthday:____________
Address:________________________________________________________________
Email add:______________________________ Contact number/s:__________________
Fathers Name: __________________________ Occupation: ______________________
Mothers Name:__________________________ Occupation: ______________________
Local Church: _______________________________IVCF Chapter:__________________
Position in IVCF chapter_______________________ IVCF staff/GT:__________________
Hobbies and special interest:
____Reading ____watching movies ____internet ____playing musical instrument
____singing ____nature trekking ____drawing ____dancing ____miming
_____arts& crafts_____ photography ____creative writing ____sports
others (pls. specify) _______________________________________________________
Special skills:_____________________________________________________________

check if you have experiences with the following in the past:

____ Horoscope reading/astrology
____participation in rituals
____tarot cards (fortune tellers through
____kulam
the use of cards)
____Idol worship
____palm reading
____quija board
____watching horror/occultic movies
____yoga
____new age
____wearing anting-anting
____drugs
____have family members
relatives
____feng shui
involve in occultic practice
____albularyo /faith healing
____incense
____heavy metal music
____dungeons and dragons
____martial arts
____others (pls. specify)
____able to see dwende
__________________________
____demon possession

Have you experience renouncing these practices? (___yes ___no) If yes, how?

Special health conditions (ex. Asthma, weak heart

etc)___________________________

Allergies / Food allergies:___________________________________________________

Persons to contact in case of emergency:

Name:________________________________
Contact No.:___________________________

Interviewer/s:
_______________________

_______________________

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