Confirmation & HS Bible Study Registration Form

Confirmation & HS Bible Study Registration Form
*** You only need to register if new student or if updating contact information. ***
Name of the Student

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Grade
Student's Cell Number (optional)
Optional, but helpful if planning activities.Format: (000) 000-0000.
Student's Email (optional)
Optional, but helpful if planning activities.
Student's Address

Street Address

Street Address Line 2

CityState

Zip Code

Parent #1 Name

First NameLast Name
Parent #1 Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent #1 Email
Parent #2 Name (optional)

First NameLast Name
Parent #2 Cell Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Parent #2 Email (optional)

Please answer the questions accordingly:

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

Baptism Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit year
Should be Empty: