2017/2018 SOTP Confirmation Registration And Basic Health Information
Registration is required for participation in our confirmation program. Please take the time to fill this form out in it's entirety. Doing so gives us the necessary contact information, student information, and medical information we need. It will also save you you time when medical release forms need to be filled out for retreats and other activities that require them.
Student Information
Student First Name
Your answer
Student Last Name
Your answer
Gender
Grade
School
Your answer
Birthdate
XX/XX/XXXX
Your answer
Has student been baptized?
Has student received his or her First Communion?
Student's Mobile Phone #
Mass texts are occasionally sent out about confirmation reminders/issues
Your answer
Please list any learning obstacles that we might encounter with your child.
(shyness, reading problems, ADD, etc.)
Your answer
What school activities, sports, or hobbies is your child involved in?
Your answer
Parent Information
Primary Contact First Name
Your answer
Primary Contact Last Name
Your answer
Primary Contact Email Address
Your answer
Primary Contact Mobile Phone #
Your answer
Secondary Contact First Name
Your answer
Secondary Contact Last Name
Your answer
Secondary Contact Email Address
Your answer
Secondary Contact Mobile Phone #
Your answer
With whom does student live with?
Home Address
Your answer
Home Phone #
Your answer
Are you members of Shepherd of the Prairie?
If you are not members of Shepherd of the Prairie, what brought you here for Confirmation?
Your answer
Do you regularly attend worship services at Shepherd of the Prairie?
Please indicate the areas you would be willing to help out with
Required
Basic Health Information
Food Allergies
Required
Food Allergy Details
(Please list details/severity of food allergies)
Your answer
Medical Allergies
Required
Medical Allergy Details
Your answer
Do we have permission to to administer basic medication to your child?
(Benedryl, Antacid, Ibuprofen, Acetaminophen, Milk of Magnesia, Cold Medicine , Antihistamines)
Please list any exceptions to us administering medications to your child.
List any of the above medications you DON'T want us to provide.
Your answer
Please list any other medical conditions that we need to know about.
Your answer
Please list any dietary restrictions
(i.e. vegetarian, lactose intolerant)
Your answer
Please list any medications that your child will take during confirmation activities (retreats, day events, lock-ins, etc.)
(Please include instructions)
Your answer
Other suggestions that may make your child's confirmation experience more enjoyable for him/her.
(Fears, anxieties, etc)
Your answer
Costs and Fees
There is a required parent/student meeting @ 7pm on September 20th, that at least one parent must attend with their child. Confirmation classes begin on Sept 27th
Your answer
I understand that there is a $25 fee to cover the cost of the supplies used during confirmation, and I will bring a check made out to SOTP on or before the Parent/Student meeting on September 20th
I understand that part of the confirmation program is attendance of the Peder Eide confirmation retreat at Lutheran Outdoors Ministries Center on November 10th - 12th. The cost of this retreat is $150, and a $50 deposit is due on or before the Parent/Student meeting on September 20th.
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