Date & Time
August 18, 2021 6:00 PM - 8:00 PM
Type
Price
Quantity
Confirmation Registration
Price
$100.00
Quantity
Enter discount code
Apply
Applying discount...
Remove
Loading...
Confirmation Registration
0
2021-2022 Confirmation Registration
Please complete all required fields (*)
Youth Information
Youth First Name
*
Youth Preferred Name
Date of Birth
*
Youth Last Name
*
Gender
*
Female
Male
Non-binary
Other
Prefer not to say
Grade Level
*
6th Grade
7th Grade
8th Grade
Future High School
*
Youth Email
*
School Attending
*
Graduation Year
*
Youth Cell Phone Number
*
Baptized?
*
Yes
No
Not Sure
Has youth received their first communion?
*
Yes
No
Not Sure
Baptism Date
Preferred Acolyte Service
*
Saturday @ 5:30am
Sunday @ 8:00am
Sunday @ 10:30am
Home Address
*
Home Address Line 2
Home City
*
Home State
*
Home Zip Code
*
Parent/Guardian Information
Parent/Guardian #1 Name
*
Parent/Guardian #1 Cell
*
Email Address
*
Relationship to Youth
*
Permission to text this number?
*
Yes
No
Preferred Method of Contact
*
Phone
Email
Both
Parent/Guardian #2 Name
Parent/Guardian #2 Cell
Secondary Email
Relationship to Youth
Permission to text this number?
Yes
No
Preferred Method of Contact
Phone
Email
Both
Alternative/Emergency Contact Information
Alternative/Emergency Contact Name
*
Alternative/Emergency Phone Number
*
Relationship to Youth
*
Youth Health Information
Do you carry medical insurance?
*
Yes
No
Insurance Carrier
*
Group/Policy Number
*
Name of Youth's Physician
*
Physician's Phone Number
*
Are youth's immunizations up-to-date?
*
Yes
No
Any health/medical conditions to be aware of? (Including mental health)
*
Yes
No
Dietary Restrictions/Allergy
Other Health/Wellness Concerns
If so, please explain
Yes
No
Medications Needed
Permissions
The aforementioned youth has permission to take part in all Confirmation activities led by Joy Lutheran Church. We agree that the Church and their personnel will not be held responsible for accidents arising therefrom.
*
Yes
No
I give Joy Lutheran Church personnel permission to seek medical treatment for the aforementioned youth in case of injury or illness.
*
Yes
No
I give permission for photos, video, and electronic images to be taken of me and/or the aforementioned youth and that they may be used by Joy Lutheran Church for promotional purposes through newsletters, flyers, and brochures, online at joylc.org or joyfulmissionpreschool.org, and church sponsored social media platforms without compensation, inspection, or approval.
*
Yes
No
