2019-2020 Confirmation Registration
Welcome to the St. Barnabas Lutheran Church Confirmation program. Please complete this form to sign up your 7th, 8th or 9th grade student.
Student's Name *
Your answer
Parent's Name(s) *
Your answer
Street Address *
Your answer
City, State and Zip Code *
Your answer
Mother's Cell Phone #
Your answer
Mother's Email Address
Your answer
Father's Cell Phone #
Your answer
Father's Email Address
Your answer
Student's Cell Phone # (optional)
Your answer
Student's Email Address (optional)
Your answer
2019-2020 Grade Level *
School *
Your answer
Emergency Contact Name (other than parent) & Relationship to Student (i.e., Jane Doe - Grandma) *
Your answer
Emergency Contact Phone # *
Your answer
Does your student have any allergies (food or otherwise) St. Barnabas should be aware of? If yes, please list below: *
Your answer
Does your student have any special behavioral issues St. Barnabas needs to be aware of? If so, please explain. *
Your answer
What do you hope your student gets out Confirmation? *
Your answer
I give St. Barnabas Lutheran Church permission to use photos and videos of my student on church run social media pages. *
I certify that all this information is correct to the best of my knowledge. *
In the event of illness or accident, if I cannot be reached, I authorize the church or its agents to consent to any diagnosis, exam, treatment, hospitalization or transportation deemed advisable for my student by and rendered under the supervision of a physician. I release the church and its agents from responsibility in case of accident or illness in connection with any church sponsored activity. *
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