Free Eye Clinic Registration
When: Date, Start time - end time Where: Event location name and street address
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How old are you?
*
How did you hear about this event?
*
Facebook
Instagram
Twitter
LinkedIn
Catholic Charities Kansas City - St. Joseph Website
Word of mouth
Newsletter
Other
Are you currently enrolled in a program at Catholic Charities KCSJ?
*
Welcome Center
Social Butterflies
Mom's Empowerment
Veteran's Services
Senior Living
Community Housing
I am not enrolled in any services
Please select an appointment time that works for you!
There are 10 appointments for each time slot listed. Once you select your time, all other options will be hidden. If you select a time and decide you would like a different time slot before submitting, you will have to refresh your page and start over.
1:00pm-1:15pm
1:15pm-1:30pm
1:30pm-1:45pm
1:45pm-2:00pm
2:00pm-2:15pm
2:15pm-2:30pm
2:30pm-2:45pm
2:45pm-3:00pm
3:00pm-3:15pm
3:15pm-3:30pm
3:30pm-3:45pm
3:45-4:00pm
4:00pm-4:15pm
4:15pm-4:30pm
Submit
Should be Empty: