2020-2021 Confirmation Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Welcome to the St. Barnabas Lutheran Church Confirmation program. Please complete this form to sign up your 7th, 8th or 9th grade student.

Student's Name *

Parent's Name(s) *

Street Address *

City, State and Zip Code *

Mother's Cell Phone #

Mother's Email Address

Father's Cell Phone #

Father's Email Address

Student's Cell Phone # (optional)

Student's Email Address (optional)

2019-2020 Grade Level *

7th Grade

8th Grade

9th Grade

School *

Emergency Contact Name (other than parent) & Relationship to Student (i.e., Jane Doe - Grandma) *

Emergency Contact Phone # *

Does your student have any allergies (food or otherwise) St. Barnabas should be aware of? If yes, please list below: *

Does your student have any special behavioral issues St. Barnabas needs to be aware of? If so, please explain. *

What do you hope your student gets out Confirmation? *

I give St. Barnabas Lutheran Church permission to use photos and videos of my student on church run social media pages. *

Yes

I certify that all this information is correct to the best of my knowledge. *

Yes

In the event of illness or accident, if I cannot be reached, I authorize the church or its agents to consent to any diagnosis, exam, treatment, hospitalization or transportation deemed advisable for my student by and rendered under the supervision of a physician. I release the church and its agents from responsibility in case of accident or illness in connection with any church sponsored activity. *

By checking this box, I agree to the above Emergency Authorization

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms