Confirmation Registration Form
Student's Name *
Your answer
Grade (Fall of 2018) *
Birthdate *
(Date/Month/Year)
Your answer
Student's Cell Phone Number
Your answer
May your student receive text messages for youth-related ministry announcements? *
Required
Student's Email
Your answer
Is your student on Facebook? *
If yes, encourage your student to like the Saint Matthew's Facebook Page!
Required
Has your child been baptized? *
Required
Baptismal Date
If known (Day/Month/Year)
Your answer
I would like to be contacted about baptism for my child.
Has your child received first communion instruction? *
Required
I would like to be contacted about communion for my child.
Parent Name *
Your answer
Parent Address *
Street, City, and Zip
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
Parent Name *
Your answer
Parent Address *
Street, City, and Zip
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
Does your child have any special needs that we as leaders should know about to better serve your child as they grow in faith? *
(ie physical, emotional, developmental) If so, please explain:
Your answer
Medical Information *
Current Medications
Your answer
Food/Drug Allergies *
Your answer
Other Health Concerns *
Your answer
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