Confirmation Certificate

Confirmation Certificate

Diocese of Western North Carolina
Dear Clergy,

This form is to be submitted to the Bishop's office following your visitation service. If applicable, list the full Baptismal names of each person Confirmed, Received or Reaffirmed in the Name column, or, if there were none, put "0" for the number of confirmations and receptions. Be sure to sign before submitting.

I will view and sign the Parish Register in observance of Title III, Canon 9.5 on the day of my visit.

Grace and Peace,

Bishop José
Date of Visitation*

MonthDayYear
Date
Congregation*
Location, if other than home Congregation
Rector/Priest in Charge*
Number of Confirmations
Number of Receptions

Please enter the following information for each person confirmed or received:

	Full Baptismal Name	Age	Address	Previous Ecclesiastical Connection	Confirmed (CONF), Received (REC) or Reaffirmed (REAF)?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Signature, Rector/Priest in Charge

Clear
Should be Empty: