High School Confirmation Signup

HOME ADDRESS *

NAME OF SCHOOL *

PLACE OF BIRTH *

STUDENT IS *

IS THERE ANY INFORMATION THAT WE SHOULD BE AWARE OF? PLEASE INCLUDE INFORMATION REGARDING ALLERGIES:

MOTHER'S MAIDEN NAME *

FATHER'S NAME *

PARENT/GUARDIAN EMAIL *

PARENT/GUARDIAN PHONE *

NAME OF EMERGENCY CONTACT (OTHER THAN MOTHER OR FATHER) *

EMERGENCY CONTACT PHONE NUMBER *

DATE OF BAPTISM (OR TYPE "NOT BAPTIZED" IF YOUR CHILD HAS NOT BEEN BAPTIZED) *

NAME AND ADDRESS OF THE CHURCH WHERE YOUR CHILD WAS BAPTIZED *

PHONE NUMBER OF THE CHURCH

DATE OF FIRST HOLY COMMUNION (OR TYPE HAS NOT MADE FIRST HOLY COMMUNION) *

CHURCH NAME AND ADDRESS WHERE YOUR CHILD MADE THEIR FIRST HOLY COMMUNION *

PHONE NUMBER OF THE CHURCH *

BY CLICKING THE BOX YOU ACKNOWLEDGE YOUR DESIRE TO SIGN YOUR CHILD UP FOR RELIGIOUS EDUCATION CLASSES AT IMMACULATE CONCEPTION CHURCH *