Confirmation Registration Confirmation 2025

CONFIRMATION YEAR 2025 - preparation begins September 2023. We meet in person at the Eden Building Sundays 3:30 - 5:15 pm or Tuesdays at 7:00pm-8:30pm. On Sundays we attend the 5:30pm Mass with parents after our session.

Each Candidate will participate in a Liturgical Ministry service and attend a Holy Family retreat once a year.
CANDIDATE'S FIRST NAME:*
CANDIDATE'S LAST NAME:*
MIDDLE NAME:
Nick Name AKA:
Date of Birth:*

MonthDayYear
GENDER:*
CANDIDATE'S EMAIL ADDRESS:*
HOME NUMBER: (xxx-xxx-xxxx)*
TEEN'S CELL NUMBER: (xxx-xxx-xxxx)
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Both ParentsMotherFatherStepmotherStepfatherGrandparent(s)GuardianOther
Candidate T-Shirt Size*

Sundays 3:45-5:15pm in the Eden CenterTuesdays 7:00pm -8:15 pm in the Eden Center
Family Information
MOTHER'S FIRST NAME:*
MOTHER'S LAST NAME:*
MOTHER'S MAIDEN NAME:*
MOTHER'S FAITH TRADITION:*
WORK PHONE: (xxx-xxx-xxxx)
CELL PHONE: (xxx-xxx-xxxx)*
MOTHER'S EMAIL:*
FATHER'S FIRST NAME:*
FATHER'S LAST NAME:*
FATHER'S FAITH TRADITION:*
WORK PHONE: (xxx-xxx-xxxx)
CELL PHONE: (xxx-xxx-xxxx)
FATHER'S EMAIL:

Medical Information
YesNo (Please submit statement below)
If no, please submit a statement indicating the limitation or serious medial condition(s).
MEDICATION: Please list any medication(s) that might need to be administered. Name of medication (over-the-counter and/or prescriptions) including dosage and frequency.
Please list any notable operations or serious Injuries: (Please include dates)
Please list any special dietary needs:
Please describe any learning issues:
Date of most recent physical exam:

MonthDayYear
Name of Physician/Clinic:
Physician/Clinic Address:
Physician/Clinic Phone Number: (xxx-xxx-xxx)
Family Health Insurance Company:
Policy Number:
Date of DPT Booster

MonthDayYear
Date of DPT

MonthDayYear
Date of Tetanus Booster

MonthDayYear
Hay FeverAsthmaSulfaNutsPenicillinGlutenOther
Treatment: If any of the above is a yes, please state how the child has been (should be) treated and with what medication.

Sacramental Information
DATE OF BAPTISM:

MonthDayYear
CHURCH OF BAPTISM:*
Address for Church of Baptism:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Upload a copy of the Baptismal Certificate

Upload a File

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DATE OF FIRST EUCHARIST:

MonthDayYear
CHURCH OF FIRST EUCHARIST:
Address for Church of First Eucharist:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please upload a copy of the 1st Eucharist Certificate if not received at Holy Family

Upload a File

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LAST GRADE OF RELIGIOUS EDUCATION:
HOME PARISH:*

Emergency Contacts
In case of an emergency, besides the parents, who should we contact?
Emergency Contact's First and Last Name:*
Relationship to Candidate:*
Primary Phone Number:*

Area CodePhone Number
Secondary Phone Number:

Area CodePhone Number
Secondary Emergency Contact's First and Last Name:
Relationship to Candidate:
Primary Phone Number:

Area CodePhone Number
Secondary Phone Number:

Area CodePhone Number
Holy Family Confirmation, Eden Center 1520 Fremont Ave. South Pasadena. CA 91030 Mailing Address: 1527 Fremont Ave. South Pasadena, CA 626.403.6128 youthministry.holyfamily.org
By Signing this document, I give permission for my child to participate in the faith formation program whether conducted onsite or online.
Signature

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Family Information