CONFIRMATION-LIFETEEN 24-25

1

Please Select 1st or 2nd Year of Confirmation or LIFETEEN* This field is required.

CONFIRMATION 1 (10th - 12th grade)

CONFIRMATION 2 (10th - 12th grade)

LIFETEEN (9th - 12th grade)

2

Teen's Last & First Name* This field is required.

Last Name

First Name

3

Teen's Middle NameSKIP IF NO MIDDLE NAME

4

Date of Birth* This field is required.

5

AGE* This field is required.

6

Gender* This field is required.PLEASE SELCT

7

Need Baptism?* This field is required.

YESNO

8

Baptism Information

Baptism Parish

City & State

Baptism Date

Country

9

PLEASE UPLOAD A COPY OF BAPTISMAL CERTIFICATEIF YOU DO NOT HAVE A COPY (PDF, JPG, IMAGE, DOC) AVAILABLE AT THIS TIME, PLEASE EMAIL WITHIN 30 DAYS.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

Need First Communion?* This field is required.

YESNO

11

First Communion Information

First Communion Parish

City & Stare

Year

Country

12

PLEASE UPLOAD A COPY OF COMMUNION CERTIFICATEIF YOU DO NOT HAVE A COPY (PDF, JPG, IMAGE, DOC) AVAILABLE AT THIS TIME, PLEASE EMAIL WITHIN 30 DAYS.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

13

School Grade* This field is required.

Please Select

14

High School Grade* This field is required.

Please Select

15

Name of High School* This field is required.

16

I give permission for son/daughter to receive info and updates via text message?* This field is required.

YESNO

17

Teen's Phone Number

Area Code

Phone Number

18

Teen's Email

example@example.com

19

TEEN'S CONFIDENTIAL INFORMATION

20

Does your teen have any special needs due to a learning disability, physical disability, reading difficulty, hearing impaired, or emotional concerns?* This field is required.

YESNO

21

Please describe special needs:

22

Does your teen take any medications?* This field is required.

YESNO

23

Please list medications:

24

Does your teen have any allergies(including food allergies) chronic illness of other conditions?* This field is required.

YESNO

25

Describe Conditions:

26

Family Address* This field is required.

Street Address

City

State / Province

Postal / Zip Code

Country

27

Mother's or Legal Guardian Full Name * This field is required.

First Name

Last Name

28

Mother's or Legal Guardian Mobile Number* This field is required.

Area Code

Phone Number

29

Mother's or Legal Guardian E-mail* This field is required.

30

Father's Full Name

First Name

Last Name

31

Father's Mobile Number

Area Code

Phone Number

32

Father's E-mail

example@example.com

33

Please sign and submit the next field. After submitting you will be redirected to our secure ONLINE PAY FORM. Make sure to select the correct fee in the REGISTRATION FEE OPTION.

CONFIRMATION REGISTRATION FEE: $100

LIFETEEN REGISTRATION FEE: $100

If you need to make payments, arrangements can be made. Do not let money be a reason not to register.

You will also receive an email confirmation of your submittal w/ a PDF ATTACHMENT with the Diocesan Permission and Liability Forms: R14, R22, and R30 forms (for you to return).

Please FILL OUT, SIGN, and do one of the following options:

Email to schristison@stanthonyfresno.org
Bring to the first meeting

Your Registration is not complete until we receive the FORMs R22B & R24.

Thank you!

By checking the next field, I understand and give permission for my son/daughter to participate both in Person and (On-Line if needed) at St. Anthony of Padua Confirmation program.

34

CONSENT* This field is required.

I AGREE AND CONSENT

35

Signature* This field is required.Parent or Legal Guardian Signature

Clear