Confirmation Registration
2022-2023
Please fill out this form separately for each child you wish to register.
Child's First and Last Name
*
First Name
Middle Name
Last Name
Grade
*
Date Of Birth
*
-
Month
-
Day
Year
Date
Has this student been baptized?
*
Yes
No
If yes, when and where?
Your child may be photographed periodically during confirmation classes. These photos are occasionally used during worship or for publicity purposes. Identifying information (including name) is never used for publicity purposes. Please indicate below your permissions regarding the use of photos of your child.
*
Allow photo use
DO NOT allow photo use
Does the student have any health concerns or allergies we should be aware of?
*
Yes
No
Please describe.
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Parent/Guardian Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Additional Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
By signing your name below you verify that you are completing the registration on behalf of the minor listed above, and are the parent/guardian whom has authorization to submit this registration for this child.
*
Clear
Submit
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