Gloria Dei Lutheran Church Rochester, MN Youth Ministry Registration: 2019-20 Confirmation Registration
Confirmation is open to youth who will be ENTERING 6th - 8th grade in Fall 2019.

Returning 7th and 8th graders do not need to complete this form unless your contact or medical information has changed.

Meeting Dates: Wednesdays evenings from September 2019 - April 2020

Time: 6:30 - 7:15 pm - Confirmation Large Group begins in worship service in sanctuary
7:15 - 8:00 - Confirmation Small Groups

Cost: $25 - one time fee covers all 3 years of confirmation
You can pay the registration fee at gloria-dei.com under "Giving" or bring a check to Gloria Dei.

No one will be turned away because of inability to pay. Contact the church office if you need assistance.

Youth's Information
Youth's First Name *
Your answer
Youth's Last Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender *
Grade *
Youth's Email Address
(Email address if they have one; parent's address will be collected below)
Your answer
Youth's Cell Phone
(Youth phone # if they have one; parent cell number will be collected below)
Your answer
I would like to be in a small group with my friend
Name of child in same grade -- we will try to accommodate your request
Your answer
Middle school I attend *
Your answer
Known Allergies or Medical Concerns *
Enter details on allergies or medical concerns that staff should be aware of in the "Other" field
Required
Permissions
By submitting this form, I give my permission for my child's photo to be used for publicity purposes. *
I give my permission for Gloria Dei staff to consent to any medical care deemed advisable by this approved emergency clinic or hospital *
Your answer
Family Information
Youth Lives with *
Gloria Dei Membership *
Parent/Guardian Name (1) *
First and Last Name
Your answer
Parent/Guardian (1) Street Address *
Your answer
Parent/Guardian (1) City *
Your answer
Parent/Guardian (1) Zip Code *
Your answer
Parent/Guardian (1) Home Phone *
Enter 'None' if no home phone
Your answer
Parent/Guardian (1) Cell Phone *
Enter 'None' if no cell phone
Your answer
Parent/Guardian (1) Email Address *
Your answer
Parent/Guardian Name (2)
First and Last Name
Your answer
Parent/Guardian (2) Street Address
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) City
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Zip Code
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Home Phone
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Cell Phone
Your answer
Parent/Guardian (2) Email Address
Your answer
Primary Contact Information
Information for first person to contact during class
Primary Contact Name *
First and Last Name
Your answer
Primary Contact Relationship to Youth *
Your answer
Primary Contact Phone *
Your answer
Volunteers
Volunteer Positions
We need small group leaders to make confirmation a success. Please consider helping out.
Comments
Additional Information/Comments
Your answer
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