Confirmation Certificate

Confirmation Certificate

Diocese of Western North Carolina
Dear Clergy,

This form is to be submitted to the Bishop's office following your Confirmation service. List the full Baptismal names of each person Confirmed, Received or Reaffirmed in the Name column, and 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 *

Month Day Year
Date
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: