Confirmation & Retreat Registration 2024-2025

Confirmation & Retreat Registration 2024-2025

Please register before September 1st
Family Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Is your family registered at Saint Margaret Mary?*

YesNo
Family ID Number
Student Information
Please select the session your student is attending for Confirmation*
Please list students you are registering for Confirmation:*
Candidate's Mother's/Guardian's Maiden Name*

Confirmation Retreat Information
What Confirmation Formation session will your student attend?*
Sunday or Wednesday
Retreat Date*

Sunday Session = Sunday, October 27th RetreatWednesday Session = Sunday, November 3rd Retreat
T-Shirt Size*

SmallMediumLargeXLargeXXLarge
If your student attends Sunday Session, their Retreat Date is Sunday, October 27, 2024

10:00 AM to 5:30 PM with Lunch and Mass included

If your student attends Wednesday Session, their Retreat Date is Sunday, November 3, 2024

10:00 AM to 5:30 PM with Lunch and Mass included

Families are invited to join us for the 4:30 PM Mass on the retreat day. Retreat ends after Mass.

Parent/Guardian Information

Parent/Guardian #1
Name:*
Relationship to Child:*
Cellular Phone *

Area CodePhone Number
Work Phone

Area CodePhone Number
e-mail:*
example@example.com
Religion:
Marital Status
Parent/Guardian #2
Name:
Relationship to Child:
Cellular Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
e-mail:
example@example.com
Religion:
Marital Status
EMERGENCY CONTACT INFORMATION
Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Physician Name:*
Phone Number*

Area CodePhone Number
In the event that I cannot be reached, I hereby give permission to the physician selected by the adult staff of Saint Margaret Mary Confirmation to secure proper medical treatment necessary for my child. I understand that I will be promptly notified in the event of any serious accident or illness and prior to any major surgery except when delay in such communication would endanger life.*

Clear
I give St. Margaret Mary permission for my youth’s participation in videos or photographs for Confirmation, which may be used for future promotional efforts, including the Diocese of Rockford website and St. Margaret Mary website and/or social media.*

NoYes
Clear
Do you have any questions that are not available on this form or the SMMYM website?
Confirmation Formation Tuition: $100 (Fee includes Confirmation Retreat)

(Cash, check or Give Central-Make checks payable to St. Margaret Mary Church)
Please select the session your student is attending for Confirmation*
Please select the session your student is attending for Confirmation*
Should be Empty: