Confirmation Registration Form Confirmation Registration (1) Student InformationStudent Name* First Last Date of Birth*Church of Baptism*Date of Baptism* MM DD YYYY Church of First Eucharist*Date of First Eucharist* MM DD YYYY School Attending the Fall*Grade in the Fall*910Home PhoneParent's Cell PhoneFamily Email Student Email Parent InformationMother's Name* First Last Mother's Maiden Name*Father's Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact InformationName* First Last Phone*Relationship*Medical Conditions/Special NeedsIs your family registered at Immaculate Conception Parish?*RegisteredNOT registeredIf not, at what parish are you registered?*Service and Volunteer ConsentPermission to participate in service and volunteer opportunities related to Immaculate Conception Confirmation Classes from September 1, 2019 until September 1, 2021. I understand that events may take place away from church grounds and this form will serve as a medical release for my child. I further consent to my child's participation with regard to transportation, i.e. parish van, chartered bus, or car.* I consent to the above Parent Name*Photo/Video ConsentPhotographs and/or videos of minors are taken periodically for use in parish publications. In checking "I agree" you are acknowledging this and granting permission to Immaculate Conception Faith Formation to use photos and videos of your child and their names in print/electronic publications and displays.*I agreeI DO NOT agreeParent Name*Other CommentsIs there anything else you would like to add?