Confirmation & High School Registration Form

Confirmation & High School Registration Form
Name of the Student*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Grade*

7th Grade8th GradeHigh School
Student's Cell Number (optional)
Optional, but helpful if planning activities.
Student's Email (optional)
Optional, but helpful if planning activities.
Student's Address*

Street Address

Street Address Line 2

CityState

Zip Code

Parent/Guardian Information
Parent #1 Name*

First NameLast Name
Parent #1 Cell Number*
Please enter a valid phone number.
Parent #1 Email*
Parent #2 Name (optional)

First NameLast Name
Parent #2 Cell Number (optional)
Please enter a valid phone number.
Parent #2 Email (optional)

Please answer the questions accordingly:

	Yes	No
Is Student member of St. Luke's?
Is Student baptized?

Baptism Date

MonthDayYear
Date
St. Luke's Church and youth leaders have permission to photograph/film the minor student above in any manner or form for any lawful purpose assicaited with St. Luke's youth programs.
Type name to agree to the above:
Name
Date

MonthDayYear
Should be Empty: