Confirmation Registration for 2021-2022
All rising 7th graders are invited to participate.
If you prefer a paper form, please contact kcarico@fumcor.org.
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Youth Full Name (Name as you would like it to appear on your confirmation certificate and Bible) *
Mailing Address *
Youth Cell Phone Number
Youth Email Address
Has youth been baptized? *
If baptized, list church, city, state, and date:
Who will youth's faith buddy/mentor be? *
Faith Buddy Address and Phone Number:
Faith Buddy Email Address
Parent Name(s) *
Parent Cell Phone Number(s) *
Parent Email Address(es) *
Permission and Medical Consent: I hereby give my permission and approval as a parent for this youth to attend any and all trips and activities sponsored by FirstYouth of FUMC Oak Ridge effective the date this form is signed. It is my understanding that these trips and activities are are approved by the church and are appropriately chaperoned by leadership and parents. This consent is in effect until written revocation is made or until graduation from high school, whichever comes first. I understand the above named youth is expected to obey all rules and regulations which will be stated prior to the event. In case of serious violation of any rules and/or regulations, I understand I may be contacted and will be expected to make arrangements, including any expenses, for my youth to return home. In the event that this youth becomes ill or sustains an injury while on a First UMC Youth event or activity, I give my permission to take said participant to a doctor or hospital and hereby authorize medical treatment including, but not limited to, emergency surgery or procedures, and assume the responsibility of all costs if necessary. I understand this consent will apply to all emergency situations, and that a copy of this form is as valid as the original. I further understand it is my responsibility to update this form should information change. *
Signature of Parent (type full name): *
Health Summary: List any chronic or recurring health problems or physical limitations: *
List medication youth takes regularly and dosage *
Youth's Primary Care Doctor and Phone Number *
Insurance Company, Policy Number, Group Number
Date of last Tetanus Shot
MM
/
DD
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YYYY
Is youth vaccinated from the COVID-19 virus?
Clear selection
Youth Date of Birth *
MM
/
DD
/
YYYY
Emergency Contact (Name, phone number): *
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