Confirmation Registration Form – Immaculate Conception Parish

Confirmation Registration (1)

Student Information
Student Name*
First Last
Preferred Name / Nickname
Preferred Name/Nickname
Student's Cell Phone Number
Student's Email Address**

* Please note, students will not be contacted without an adult on copy to ensure safe environment protocol.
Date of Birth*
Church of Baptism*
Date of Baptism*
Month
Day
Year
Church of First Eucharist*
Date of First Eucharist*
Month
Day
Year
School Attending the Fall*
Grade in the Fall*
Home Address*
Street Address City State ZIP Code
Home Phone
Parent Information
Mother's Name*
First Maiden Name Last
Mother's Cell Phone
Mother's Email Address
Father's Name*
First Last
Father's Cell Phone
Father's Email Address
Emergency Contact Information
Name*
First Last
Phone*
Relationship*
Medical Conditions/Allergies/Educational Needs
Is your family registered at Immaculate Conception Parish?*
- Registered
- NOT registered
If not, at what parish are you registered?
Service and Volunteer Consent
Permission to participate in service and volunteer opportunities related to Immaculate Conception Confirmation Classes from June 1, 2023 until June 1, 2025. 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 and Online Learning Consent
Photographs 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 agree
- I DO NOT agree
Virtual On-Line Learning Permission: If necessary, my child has my permission to participate with on-line Catechesis with Immaculate Conception. I understand that a subsequent email will be forwarded providing the dates and times of the sessions.*
- I give permission.
- I DO NOT give permission.
Parent Name*
Other Comments
Is there anything else you would like to add?
Payment
Please indicate your method of payment.*
- Cash/Check (Please mail or drop in the rectory door mail slot at Parish Office.)
- Online payment (Once you submit this form you will receive a pop up that will provide a link to pay online.)
FEE FOR THE TWO YEAR PROGRAM IS $125. Registration and Fee are due July 31, 2023. Please note, registration is not complete without payment. Late registrations will be handles on an individual basis. (If student fee presents a hardship, please call email Gail Cappozi at gcappozi@syrdio.org).

Confirmation Registration (1)

Student Information

Parent Information

Emergency Contact Information

Service and Volunteer Consent

Photo/Video and Online Learning Consent

Other Comments

Payment