Confirmation

Parent/Guardian 1
Contact Information

Full Name REQUIRED Please fill out this field. Please enter valid data.

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

Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian 2
Contact Information

Full Name Please enter valid data.

Phone Number Please enter valid data.

Email Please enter valid data.

Primary Mailing Address

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.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Emergency Contact

Full Name REQUIRED Please fill out this field. Please enter valid data.

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

Relationship to Child REQUIRED Please fill out this field. Please enter valid data.

Youth Liability Waiver

I consent to photographs or videos being taken of my child/ward to be used in Parish or Diocesan publications. REQUIRED Yes No Please fill out this field.

I certify that my child/ward is physically fit and adequately prepared to participate in this event. REQUIRED Yes No Please fill out this field.

In the event of an emergency, I hereby grant permission to transport my child/ward and obtain emergency medical or surgical treatment(s) from a licensed physician, hospital, or medical clinic. REQUIRED Yes No Please fill out this field.

I wish to be advised in the event of an emergency and prior to further treatment by the medical provider. REQUIRED Yes No Please fill out this field.

Number of Students to Register REQUIRED Please fill out this field.
Student's Information 1
- Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade (Fall 2024) REQUIRED Please fill out this field.
- Allergies Please enter valid data.
- Are there any medical conditions, disabilities, or other important information we should know about your child? Please enter valid data.
- Sacraments Received
- Church of Baptism Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Date of Baptism Please enter valid data.
- Church of First Communion Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of First Communion Please enter valid data.
Student's Information 2
- Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade (Fall 2024) REQUIRED Please fill out this field.
- Allergies Please enter valid data.
- Are there any medical conditions, disabilities, or other important information we should know about your child? Please enter valid data.
- Sacraments Received
- Church of Baptism Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Date of Baptism Please enter valid data.
- Church of First Communion Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of First Communion Please enter valid data.
Student's Information 3
- Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade (Fall 2024) REQUIRED Please fill out this field.
- Allergies Please enter valid data.
- Are there any medical conditions, disabilities, or other important information we should know about your child? Please enter valid data.
- Sacraments Received
- Church of Baptism Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Date of Baptism Please enter valid data.
- Church of First Communion Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of First Communion Please enter valid data.
Student's Information 4
- Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade (Fall 2024) REQUIRED Please fill out this field.
- Allergies Please enter valid data.
- Are there any medical conditions, disabilities, or other important information we should know about your child? Please enter valid data.
- Sacraments Received
- Church of Baptism Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Date of Baptism Please enter valid data.
- Church of First Communion Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of First Communion Please enter valid data.
Student's Information 5
- Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade (Fall 2024) REQUIRED Please fill out this field.
- Allergies Please enter valid data.
- Are there any medical conditions, disabilities, or other important information we should know about your child? Please enter valid data.
- Sacraments Received
- Church of Baptism Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Date of Baptism Please enter valid data.
- Church of First Communion Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of First Communion Please enter valid data.

How Can You Help?

Which of the following volunteer needs can your family assist with this year? (Please reach out if you have any questions about a volunteer need.) Apple Squeeze (September 28) Making Advent Wreaths (November 24) Christmas Caroling at Kimball Farms (December 15) Epiphany Pageant (January 4) Washing of the Feet (April 13) Easter Egg Hunt (April 20) First Holy Communion (May 18) We cannot commit at this time.

Thank You for Your Support!
Your weekly offering makes it possible for our Faith Formation program to be free for all families. We appreciate your continued support!