Matejko Polish School-Confirmation-Retreat Registration 2026-2027

Matejko Polish School-Confirmation & Retreat Registration 2026-2027

Please register before September 1st
Family Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number

Area CodePhone Number
Is your family registered at Saint Margaret Mary?
Family ID Number
Student Information
Please list students you are registering for Confirmation:
Candidate's Mother's/Guardian's Maiden Name

Confirmation Retreat Information
Retreat Date is Sunday, November 1, 2026

9:00 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.

Retreat fee is $20

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.
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.
Parent Signature
Do you have any questions that are not available on this form or the SMMYM website?
Confirmation Formation Sacramental Supplies: $20 (Confirmation Retreat)

(Cash, check or Give Central-Make checks payable to St. Margaret Mary Church)
Should be Empty:

Matejko Polish School-Confirmation & Retreat Registration 2026-2027