2023-2026 Confirmation Registration

Registrant

First Name

Last Name

Preferred Name on Bible and Confirmation Certificate

Address

Home

If your student has their own phone, please provide their phone number here.

Mobile

Birthday

/ /

Gender

Baptized as infant or child?

If yes, please provide place of baptism.

Friend Request to be in a group/cabin with

Current Grade Level

Middle School

If your student does not attend a school listed above, please enter their school here.

Attends Other School?

Mother's Full Name

Mother's Cell Phone

Mother's Email

Father's Full Name

Father's Cell Phone

Father's Email

Student lives with

Name/Address/Phone/Email of Other if Applicable

Friend Request to be in a group/cabin with

Student Photo

Upload

Please upload a current photo of your student for the internal church database.