Confirmation Registration  

                                                                                                                                                                                                                                                           Registration Paid $______________

                                      Fee:  $15 per student/ $25 per family

                                                                       (Separate from Sunday School fees)

Confirmation Student Information

FULL NAME: ____________________________________________  Grade: ______________

     (Please include middle name)

Prefer to be called: _______________________       Date of Birth: ________________________

Church Home: ___________________________     Student Cell Number: __________________

Student Email Address: __________________________________________________________

                                                                              (please print)

Student on Facebook?     _________ Yes        _________ No

Parent’s Name: __________________________         Parent’s Name _______________________

Address: _______________________________         Address:  ___________________________

                 _______________________________                          ____________________________

Email Address: ___________________________    Email Address:_______________________

                                   (please print)                                                                           (please print)

Phone (home)    _(_____)_____________________      Phone (home)    _(_____)________________

              (work)   _(_____)_____________________                    (work)   _(_____)________________

              (cell)      _(_____)_____________________                    (cell)      _(_____)________________

Dietary, allergies or learning issues we should be aware of: