All Saints Youth Confirmation: Online Registration Form

FAMILY'S LAST NAME REQUIRED Please fill out this field. Please enter valid data.

Home Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field. Please enter valid data.

Zip Code REQUIRED Please fill out this field. Please enter valid data.

Home Phone REQUIRED Please fill out this field. Please enter valid data.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Work or Cell Number REQUIRED Please fill out this field. Please enter valid data.

Email Address Please enter valid data.

Mother's First and MAIDEN Name REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Work or Cell Number REQUIRED Please fill out this field. Please enter valid data.

Email Address Please enter valid data.

With whom do the children live? REQUIRED Please fill out this field. Please enter valid data.

Guardian's

If the child(ren) live with someone other than their parents, please fill out the following information:
Guardian's Name
And Religion
Please enter valid data.
Work or Cell Number Please enter valid data.
Emergency Contact Name Please enter valid data.
Emergency Contact Work or Cell Number Please enter valid data.
Relationship to the Child Please enter valid data.
How Many Children? REQUIRED Please fill out this field.
1st Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number Please enter valid data.
Email Address REQUIRED Please fill out this field. Please enter valid data.
CONFIRMATION YEAR REQUIRED ONE TWO Please fill out this field.
Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Age REQUIRED Please fill out this field. Please enter valid data.
Name of High School REQUIRED Please fill out this field. Please enter valid data.
Grade REQUIRED 9th 10th 11th 12th Please fill out this field.
Has the child been Baptized? REQUIRED
If YES, fax or mail a copy of Baptisim Certificate to the church office.
Please fill out this field.
What date? and Which Church?
Received First Communion? REQUIRED
If YES, fax or mail a copy of the First Communion Certificate to the church office.
Please fill out this field.
What Date? and Which Church?
2nd Child's Full Name Please enter valid data.
Cell Phone Number Please enter valid data.
Email Address Please enter valid data.
CONFIRMATION YEAR ONE TWO
Date of Birth Please enter valid data.
Age Please enter valid data.
Name of High School Please enter valid data.
Grade 9th 10th 11th 12th
Has the child been Baptized?
If YES, fax or mail a copy of Baptisim Certificate to the church office.
What Date? and Which Church?
Received First Communion?
If YES, fax or mail a copy of the First Communion Certificate to the church office.
What Date? and Which Church?

Acknowledgement and Conformity

As the parent(s)/guardian(s) of the child(ren) listed on this form, I hereby give my permission of his/her participation in any and all Confirmation activities. I agree to direct my child to cooperate and conform to directions and instructions of Confirmation personnel responsible for Confirmation activities. I agree that in the event my child is injured as a result of his/her participation in the Confirmation activities, including transportation to and from those activities, whether or not caused by the negligence of the parish/school Confirmation program, or any of its agents or employees, recourse for the payment of any resulting hospital, medical, or related costs and expenses will first be had against any accidents, hospital, or medical insurance, or any available benefit of mine/ ours.
In the event I cannot be reached in any emergency, I give permission to the following adult(s) to make decisions on my behalf (also include contact information):
I give permission to the following adults,their contact information and relationship to child

Agreement/Acceptance to the Terms:

To authorize by accepting below whatever medical treatment may be considered necessary by the attending physician for my /our child. I have read the information included in this packet and I agree to all conditions required for my child's participation in the confirmation program, including regular mass attendance, 10 hours parent volunteer service, and attendance of all parent information meetings and family activities.
I accept: REQUIRED Please fill out this field.

All Saints Catholic Church

Making Jesus Known

All Saints Youth Confirmation: Online Registration Form