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Rebuilding Registration Form

We treat your personal information as confidential and will release it only as might be necessary to serve you, and only to duly recognized representatives of the Diocese of St. Augustine or the priest(s) and parish(es) you designate below. 

Click here for more information on our Privacy Policy.

This a structured eleven-week educational seminar for separated, divorced and widowed persons.  It is a closed group which studies and prays together in confidentiality with compassionate support. The sessions are facilitated by experienced and professional leaders.  The classes are held in two locations, Jacksonville and Palm Coast, are open to all denominations and require pre-registration.  For more information contact the Diocesan Center for Family Life at (904) 308-7474.

Jacksonville

The next Rebuilding classes will begin on March 15, 2012 and continue each Thursday evening through May 17, 2012. Cost is $40.00 for the program.  Classes are held at the Catholic Center, 11625 Old St. Augustine Rd., Jacksonville and begin at 7 PM each evening.

General Information:
First Name
Last Name
Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
E-mail
Date of Birth

Marital Status:
 

 Widowed

Divorced

Separated

Date of Separation/Divorce/Loss

How did you hear about this program?


What do you expect to gain from this program?



Are you interested in learning more about additional programs?

 Yes

No    

Do you have an annulment?

 Yes

No    

Can we provide you with annulment information?

 Yes

No    

Select a Payment Method:

VISA   MasterCard   Check    Other

If paying by credit card, please complete requested information on the next page.

Comments:

If paying by credit card, confirmation will be sent by e-mail (if provided) or by mail.
If paying by check, confirmation will be sent by e-mail (if provided) or by mail ONLY when your check has been received.  Checks should be made out to Diocesan Center for Family Life.

Any questions, please contact (904) 308-7474



    

"The Lord has turned all our sunsets into sunrise."

St. Clement of Alexandria

  
 2577 Park Street    
   Jacksonville, FL 32204    
   Phone (904) 308-7474    
Copyright © 2007 Diocesan Center for Family Life                                                                                             Fax (904) 308-4087    

                                            Diocese of St. Augustine