Confirmation Registration Form Confirmation Registration (1) Student InformationStudent Name* First Last Student's Cell Phone NumberStudent'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* 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 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 there anyone with compromised immune system in the home?*YesNoIs 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 July 1, 2020 until July 1, 2022. 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?PaymentPlease 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, 2020. Please note, registration is not complete without payment. (If student fee presents a hardship, please call the IC Youth Office, 637-2375).