Confirmation Registration

Student's Name

First Last

School Attending

Grade

Birthdate

Baptism Birthdate

Student Cell Phone

Siblings Names and Ages

Parent / Guardian Name 1

First Last

Parent / Guardian Email 1

Parent / Guardian Cell Phone 1

Parent / Guardian Name 2

First Last

Parent / Guardian Email 2

Parent / Guardian Cell Phone 2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please check a box if your student is in 8th Grade and is attending the Confirmation Retreat August 16-18.

My student will attend

My student will not attend

Confirmation Registration Fee

Price:

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

This field is for validation purposes and should be left unchanged.