2018-2019 Confirmation Registration
Sign up your 6th, 7th or 8th grade student for Confirmation
Student's Name *
Your answer
Parent's Name(s) *
Your answer
2017-2018 Grade Level *
School *
Your answer
Address *
Your answer
Parent/Guardian Cell Phone # (555-555-5555) *
Your answer
Alternate Phone # (555-555-5555) *
Your answer
Student Cell Phone # (555-555-5555) *
Your answer
Email *
Your answer
Emergency Contact Name (other than parent) + Relationship to Student (i.e. Louise Johnson - Grandma) *
Your answer
Emergency Contact # (555-555-5555) *
Your answer
Does your student have any allergies (food or otherwise) Bethany needs to be aware of? If yes, please list below.
Your answer
Does your student have any special behavioral issues Bethany needs to be aware of? If so, please explain.
Your answer
What do you hope your student gets out of Confirmation?
Your answer
Each year, we pair mentors with students during Lent (4 week commitment). I would like to sign up as a mentor this year. *
I give Bethany Lutheran permission to use photos of my child on church run social media pages. *
My student is involved in outside activities that will likely take him/her out of Confirmation five or more times during the year. *
I certify that all this information is correct to the best of my knowledge. *
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