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Registration Form

Presentation Quest: Immersion and Service Experiences

Schedule Your Own Service
Cultural Immersion, Okolona, MS
Presentation Lantern Center, Dubuque, IA
Sisters of the Presentation, Dubuque, IA

Registration Form

Scheduled Events

Schedule Your Own Service

Do you need transportation?  Yes  No
(10 digits inc. area code)
(10 digits inc. area code)
Can we email you with upcoming events and news?  Yes  No
Do you have a valid driver's license?  Yes  No
Current health insurance provider:
Have you had a tetanus shot within the last 10 years?  Yes  No
(If no, participant MUST complete vaccination prior to departure)
Person to be notified in an emergency:
(10 digits inc. area code)
(10 digits inc. area code)
Briefly explain your interest this program:
List and describe service experiences that you have had in the past.
(i.e. visiting nursing homes, campus ministry projects, serving meals, etc.)
Do you bring any specific skills to this project?
(i.e. playing an instrument, construction, healthcare, bilingual, etc.)
Do you have personal concerns/hesitations about being involved in this project?
Do you know or have ever worked with Presentation sisters?

I will abide by the directives of trip sponsors and coordinators, and of the local site directors. I realize that participation in this service is contingent upon meeting the expectations which they specify. I do not/will not hold either the coordinators nor sponsoring institutions responsible for illness, injury or accidents.

Three references are needed. We suggest two from the following: principal, dean of students, teacher, past service supervisor, youth minister, pastor, campus minister, guidance counselor, employer, etc. (Presentation sisters and associates, past participants of Presentation sponsored immersion trips need not complete references.)

Trip size is limited. All forms must be returned for the application to be considered: 1) return registration form 2) return reference form to: Sisters of the Presentation, Presentation Quest Coordinator, 2360 Carter Road, Dubuque, IA 52001 or email it to service@dubuquepresentations.org.

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