Confirmation Registration
South East Bucks Pastoral Area Confirmation 2019
Dear Parent/Guardian,

The Pastoral Area of the Venerable Mary Ward, comprising the parishes of Immaculate Heart of Mary, Our Lady of Perpetual Succour, St Aidan’s, St Columba’s and St Joseph’s, invites young people in Year 9 or above to register now for our 2019 Confirmation programme.

Thank you for taking the time to complete this form and if you have any questions please do not hesitate to contact us.

The information provided below will be used for conducting the Confirmation preparation programme, administrating the sacrament and related activities. This information will not be shared outside our pastoral area administration.

If you wish, please go to your parish website or contact your Parish Office to register your family for all other ongoing parish communications as your details are not automatically added to parish records without your explicit consent in line with data protection policy.


Paul Rayner and Brian Gallagher
Pastoral Area Confirmation Leaders

Instructions
There are four sections to this form:
1. Candidate Registration Information
2. Parent/Guardian Contact Information
3. Medical Details and Roman Catholic Diocese of Northampton Consents
4. Code of Conduct

You will need to have the following to complete this form in full:
- Name and full address of the church where your child was baptised.
- Name and contact information for your GP

The form will not 'save' your information if you partially complete it so please gather this detail before you begin. You need to click on the grey line under the question, it will turn brown for you to begin typing. Please use capitals as appropriate and NOT all capitals :) Thanks.

1. Candidate Registration Information
Please Note: All information provided by you below is for conducting the preparation programme and administering the Sacrament of Confirmation. It will be managed in line with the Diocesan Privacy Policy, which can be found on their website.
Candidate's First Name *
Your answer
Candidate's Surname *
Your answer
Candidate's Date of Birth *
MM
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YYYY
Candidate's Date of BAPTISM *
MM
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DD
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YYYY
Name and Address of Church of Baptism - in full including post code *
We have to inform the parish where your child was baptised of their confirmation. Please type out the baptismal church as if you were addressing the envelope yourself, as we copy and paste this to mail them after the confirmation. Please do not use all CAPS. If the answer is St Joseph's or Holy Name, Denham, full address is not required.
Your answer
Current Parish *
If your current parish is not listed, tick the 'Other' box and see "ADD any notes here... " further down the form.
Primary School Attended *
If your child's primary school is not listed, tick the 'Other' box and see "ADD any notes here... " further down the form.
Current School *
If your child's current school is not listed, tick the 'Other' box and see "ADD any notes here... " further down the form.
Regular Church & Time for Sunday Mass *
If your regular church & time for Sunday mass is not listed, tick the 'Other' box and see "ADD any notes here... " in the next question
ADD any notes here re: Primary School, Secondary School or Regular Church/Time for Sunday Mass
Please provide any extra information from the above questions where a drop down answer was not valid.
Your answer
Mass Ministry can count towards service hours for Confirmandi.
If the candidate would like to join a particular ministry please select below. Support from the younger members of the congregation would be most appreciated.
If you wish to take part in music ministry please specify which instrument you play or if you sing.
Your answer
2. Parent/Guardian Contact Information
Full Name of Parent/Guardian Completing this Form *
Your answer
Relationship to Candidate *
Parent, guardian, grandparent
Your answer
Parent/Guardian Email Address *
If you wish to add more than one email address, please separate with a comma.
Your answer
Full Home Address - including postcode *
Please type out address in full and put the postcode (only) in all caps, using usual capital letters as appropriate - we copy and paste this information!
Your answer
Home Phone Number *
Your answer
Parent/Guardian Mobile Phone Number *
Please note at the end of the number whose phone it is eg: 01753 123456 Jane
Your answer
3. Medical Details and Roman Catholic Diocese of Northampton Consents
Group Leaders: Paul Rayner and Brian Gallagher
Please note that the medical consent signed for below will only be exercised in emergency circumstances when the parent or guardian are unreachable.
Does your child have any medical condition? *
If yes, please provide details here
Your answer
List all regular medication or treatment *
Name/dosage/purpose/self-administered? Write 'None' if none.
Your answer
Are there any activities that your child cannot participate in? *
Please write 'No Restrictions' if applicable.
Your answer
Any specific dietary requirements? *
Please note them here or state 'None'
Your answer
Name and contact details of your child's GP *
Please include doctor's name, medical practice and contact telephone number
Your answer
MEDICAL CONSENT: I give permission for my son/daughter to take part in the activity mentioned above. I confirm that he/she is in a healthy condition to participate in the activity mentioned above. I understand that I will be contacted in the event of my son/daughter being taken ill or injured during the period of the above event, and that my consent will be requested for any treatment deemed necessary by the appropriate medical authorities. *
In the event that I am not able to be contacted and to the extent that a surgical operation or injection becomes necessary, I authorise the above mentioned group leaders to sign on my behalf any forms of consent requested by the medical authorities, provided the delay required to obtain my own signature might be considered likely to endanger his/her health or safety. I authorise the group leaders to administer first aid in an emergency that requires an epi-pen or other deposited medicines that I have listed above as regular medication or treatment.
PHOTO CONSENT: I give permission for my child to be photographed at Youth and Confirmation events to be used for the South East Bucks Pastoral area (e.g. parish websites, reports, bulletin boards, etc) and for the Diocesan newspaper The Vine. I understand that no names will be listed with the photos to protect my child. *
4. Code of Conduct
In order for us to get the most out of our programme and confirmation experience, we have some guidelines and expectations that we would like everyone to meet. These are basic expectations which will help us to be involved in the program, show appropriate respect, learn and stay safe.

I am expected to:

• Attend Mass regularly
• Arrive on time every session
• Complete my 10 hours Parish Service
• Listen when the confirmation leaders or small group leaders are talking
• Listen to the others in my group
• Obey the instructions of my small group leaders and the confirmation leaders
• Participate in my small group sessions and in the life of the group
• Show respect to all involved in the programme

The following will be deemed unacceptable behaviour:

• Use of offensive or discriminatory language
• Inappropriate or disruptive behaviour
• Disrespect towards other participants or towards a leader
• Bullying or intimidation of any kind

Discipline Process

If you fail to uphold any of these expectations, one of the group leaders will make you aware of what you are doing wrong. We would then expect you to change. If you don’t and they are required to ask you again, the confirmation leader will be made aware and they will ask you to explain why you are not meeting the appropriate standards of behaviour. If you are a persistent offender or if your actions are deemed to be of a serious nature, the confirmation leaders have the power to inform your parents and to remove you from the course.

Agreement by Confirmation Candidate *
I have read and understand the code of conduct and am willing to abide by it for the duration of the course
Required
Agreement by Parent/Guardian of Confirmation Candidate *
I agree with the expectations expressed in the code of conduct and am happy for the confirmation leaders to implement appropriate disciplinary measures if these are not upheld by my son/daughter.
Required
Further to the initial meeting on Monday 15th October
Session location *
My child will attend
I am interested in helping with the following - please get in touch with me *
Tick all that apply
Required
Any comments or questions you wish to add at this time
Please write them here and one of the team will get back to you.
Your answer
Sign Off Date *
Date the form was completed and submitted
MM
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DD
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YYYY
THANK YOU
Thank you for taking the time to complete this registration form. Please contact your local Parish Office if you have any questions.

After you press the SUBMIT button below you will get a thank you for submitting your form message. Should you have any problems, please print your completed form and return it to your local Parish Office.

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