Confirmation II Waivers/Registration 2021-2022

Confirmation Year 2 Waivers/Registration

Purpose by Life Teen | Holy Trinity Catholic Church | 2021-2022 School Year
We are very excited to continue the Faith Formation Process with a new Confirmation Program named 'Purpose' by Life Teen! For more information, please visit: https://holytrinityladera.org/sacraments/confirmation/

Registration & payment for Confirmation Year 1 & 2 have been received if Year 1 was completed at Holy Trinity Church.

If you are transferring from another parish, please have the Baptism Certificate of the Teen ready to upload. If you do not have the baptism certificate, please contact the parish at which your child was baptized.
*please have the letter of transfer and card payment for $150 at hand for Registration.
Are you transferring from another Parish? *

No Yes
What Church and City is your Teen transferring from? *
Upload transferring Parish Year 1 Confirmation Completion Letter: *

Cancel of

Student Participant Information
Name *

First Name Last Name
Gender *

Male Female
Date of Birth *

Month Day Year
Date
What School does your teen attend? *
Grade *
Faith Formation Information
Has your teen received their Baptism? *

Yes No Yes, at Holy Trinity
Has your teen received their First Communion? *

Yes No Yes, at Holy Trinity
Name of Church your teen was Baptized in: *
Date of Baptism *

Month Day Year
Date
Address of Church Baptized in: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Baptism Certificate *

Cancel of
What Church and City did your Teen receive their First Communion? *

Parent/Guardian Information
Is your family registered in our Parish? *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Mother's Name: *

First Name Last Name
Mother's Maiden Name *
Mother's Cell Phone Number *
Mother's Cell Phone Number (update if needed)
Mother's Email *
example@example.com
Mother's Email (update if needed)
example@example.com
Father's Name: *

First Name Last Name
Father's Cell Phone *
Father's Cell Phone (update if needed)
Father's Email *
example@example.com
Father's Email (update if needed)
example@example.com
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe. If not please write N/A. *
Is the participant prescribed an Epi-Pen or Inhaler? If yes, please explain any instructions. If not please write N/A. *

Permission, Liability, Media & Medical Waiver
I, [the parent (guardian)] of, name of student* hereby give my permission for my child's participation in 'Confirmation Preparation' from 2021-2022 school year at Holy Trinity Catholic Church. As a condition of my child being allowed to do so, I hereby release and discharge the Diocese of Orange, Holy Trinity Catholic Church, its constituent organizations, including, but not limited to, The Roman Catholic Bishop of Orange, a Corporation Sole, and their officers, employees and volunteers from any and all claims for personal injuries or property damage that s(he) may suffer as a result of his/her participation in the activity described above, whether or not such injuries or damages are caused by the negligence, active or passive, of any of the entities or individuals named or described above.

I agree to direct my child to cooperate and follow directions and instructions of parish, or Diocesan personnel responsible for all activities.

I agree, that in the event of injury as a result in my or my child's participation in the above activity, including transportation to and from these activities, whether or not caused by the negligence, active or passive, of the parish, school, or Diocesan youth activities program or any of its agents, employees or volunteers, recourse for the payment of any resulting hospital, medical, dental treatment or related costs and expenses will first be had against any accident, hospital, medical or dental insurance, or any available benefit plan of mine or my spouse. I am not aware of any medical condition which would render it inappropriate for participation in any activity.

I hereby give permission to the physician, nurse, dentist or licensed care staff selected by the supervisory personnel then present to render medical, dental or other appropriate treatment deemed necessary and appropriate by the physician, nurse, dentist or licensed care staff.

I, hereby, authorize the making of photographs, motion pictures, video tapes, or other recordings memorializing said event and my child’s participation therein, and the publication and duplication or other use thereof. I, hereby, waive any rights to compensation or any right that I otherwise might have to limit or to control such making or use.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Health Insurance Information
Insurance Carrier: *
Policy/Group Number: *
Policy Number:
Parent Name *

First Name Last Name
Parent/Guardian Signature *

Clear

Payment: *

Confirmation Year 2 Registration (2021-2022) *no refunds may be processed

$ 125.00

Total

$ 0.00

Credit Card

Should be Empty:

Confirmation Year 2 Waivers/Registration

Faith Formation Information

Permission, Liability, Media & Medical Waiver

Health Insurance Information

Credit Card