2024-25 Confirmation Registration

NOTE: Please register each student separately.

Student Full Name*

First NameLast Name

Date of Birth*

Date

Gender*

2024-25 Grade Level*

If you selected "other", please indicate your grade level:

Ex. 10th

Are you New or Returning?*

NewReturning

Please Indicate Year in Confirmation*

First YearSecond YearThird Year

Please let us know of any learning accommodations that can be made to help your student.

Mother/Guardian Name *

FirstLast

Father/Guardian Name *

FirstLast

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

We communicate important information by email and texting. Please include email and cell phone number for everyone who needs to receive information.

Mother/Guardian Email *

example@example.com

Additional Email (optional)

example@example.com

Mother/Guardian Cell Phone Number*

Area CodePhone Number

Father/Guardian Email*

example@example.com

Additional Email (optional)

example@example.com

Father/Guardian Cell Phone Number*

Area CodePhone Number

OPTIONAL: Please fill out the next section ONLY if secondary parent/guardian information needs to be listed.

Additional Parent/Guardian

FirstLast

Additional Parent/Guardian Email

example@example.com

Additional Parent/Guardian Cell Phone Number

Area CodePhone Number

Additional Parent/Guardian

FirstLast

Additional Parent/Guardian Email

example@example.com

Additional Parent/Guardian Cell Phone Number

Area CodePhone Number

PERMISSIONS

Liability Disclosure: Every activity sponsored by Hales Corners Lutheran Church and/or Hales Corners Lutheran School (hereinafter "Church"), is carefully planned and adequately supervised by mature adults. However, even with the best planning and precaution, unforseen events can occur. This disclosure is made to all participants, whether through his/her parent or guardian or as an adult on his/her own behalf, to inform employees and volunteers are not negligent.

Liability Disclosure Acceptance*

Please type your name or initials to accept.

Photo/Video: During Confirmation, photos and/or videos will be taken for use in ministry promotion for HCLC. Names will not be used. If your child cannot be photographed, please send a written request (not on this form) to Julie Crowe at jcrowe@hcl.org.

The price below includes a non-refundable 3% convenience fee.

Payment

Confirmation Registration$100.00

Enter coupon

Total $0.00

Credit Card

Confirmation Registration 2024-25

Credit Card