2024 CONFIRMATION REGISTRATION

Student Full Name*

First NameMiddle NameLast Name

Student Preferred Name*

Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Birthdate*

Date

Student Gender*

Student's 5th Grade Elementary School*

Student's 6th Grade School, Fall 2024*

Student T-Shirt Size (Adult Sizing)*

SMLXL

Has Student Been Baptized?*

YesNo

Approximate Date & Location Of Baptism*

Parent/Guardian (1) Name*

First NameLast Name

Parent/Guardian (1) Email*

Confirmation EmailPlease retype to confirm correct

Parent/Guardian (1) Phone*

Is Parent/Guardian (1) Address Same As Student?*

YesNo

Parent/Guardian (1) Address If Different From Student*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Would you like to add another Parent/Guardian?*

YesNo

Parent/Guardian (2) Name*

First NameLast Name

Parent/Guardian (2) Email*

Confirmation EmailPlease retype to confirm correct

Parent/Guardian (2) Phone*

Is Parent/Guardian (2) Address Same As Student?*

YesNo

Parent/Guardian (2) Address If Different From Student*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Other Than Parent/Guardian*

First NameLast Name

Relation To Student

Aunt, neighbor, friend, etc.

Emergency Contact Primary Phone*

Emergency Contact Secondary Phone

Student Primary Physician*

First NameLast Name

Physician Phone*

TRAVEL & EMERGENCY MEDICAL CARE RELEASE

I (we) give our student permission to attend and participate in the Confirmation activities at Trinity United Methodist Church. I (we) recognize that membership and participation in this program is voluntary, and while every reasonable precaution will be taken for the safety and well-being of the participants, there are certain risks inherent in trips away from home and church. I give permission for my child to ride in the vehicles Trinity UMC will be using to travel to ministry destinations.

In the event of an emergency illness or injury to the child, an adult leader of this program will make every reasonable effort to contact me (us) for permission to obtain emergency medical and/or dental care. However, if the circumstances do not permit, I (we) authorize and consent to such emergency medical and/or dental care and treatment as may be necessary for the prompt treatment of the illness or injury. I (we) further agree to be financially responsible for the cost of emergency treatment and agree to reimburse Trinity and/or the adult leaders for any expense incurred as a result of such emergency treatment.

Travel & Medical Care Consent*

Electronic Signature of Consenting Parent/Guardian

Insurance Company*

Policyholder's Name*

First NameLast Name

Member ID*

Group Number*

N/A if Unknown

Please list any family structure information, medical conditions, food and/or medication allergies, current medications, dietary restrictions and any special needs this student may have that will help our staff keep your student safe and well. If nothing applies, type NONE.*

MEDIA RELEASE

I give permission for photographs/videos in which my child(ren) appear to be used for publications and public relations activities by Trinity United Methodist Church. This may include, but not limited to, use in print/electronic media, social media, and the internet.

Media Policy Consent

Electronic Signature of Consenting Parent/Guardian

We ask for a registration fee of $250 for each Confirmand. These monies go to offset the cost of materials, travel, t-shirts, the retreat, Discovery Weekend and the Confirmation celebration. Because our church is committed to inviting all 6th graders into a deeper relationship with Christ through the process of Confirmation, we do not want a registration fee to be a barrier for participation. Please select the appropriate response below and email Kristi separately to request a confidential scholarship (kedwards@trinitybirmingham.com).

How Would You Like To Pay?*

I'd like to pay online nowI'll send a checkI'd like to request a scholarship

Great! Please make check payable to Trinity United Methodist Church, memo: Confirmation and student's name, and drop by the church office or mail to 1400 Oxmoor Road, Birmingham, AL 35209.

We don't ever want a financial burden to keep a student from participating. Please email Kristi Edwards (kedwards@trinitybirmingham.com), our Confirmation Coordinator, to request a scholarship.

CONFIRMATION PAYMENT PORTAL*

2024-2025 Confirmation Fee

$250.00 Quantity

Total

$0.00

If you experience trouble processing a payment after the submit button has been pressed, please do not hit the submit button again, but instead email Robert Sturdivant (rsturdivant@trinitybirmingham.com) for assistance. Thanks!

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

TRINITY UNITED METHODIST CHURCH - CONFIRMATION REGISTRATION 2024

CONFIRMAND

PARENT/GUARDIAN

MEDICAL

TRAVEL & EMERGENCY MEDICAL CARE RELEASE

INSURANCE

ADDITIONAL INFORMATION

PAYMENT