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2022 - 2023 Registration
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* Indicates required question
Student Name
*
Your answer
Gender Identity & Pronouns
*
Male (he/him/his)
Female (she/her/hers)
Non-binary (they/them/ their)
Prefer not to say
Other:
Grade (2022-2023 school year)
*
6th
7th
8th
Other:
Birthday
*
MM
/
DD
/
YYYY
Optional: Student email
Your answer
Optional: Student phone number
Your answer
Has your student been baptized?
*
Yes
No
Other:
Dietary Restriction
*
Vegetarian
Gluten-free
Vegan
Dairy-free
Allergies
Other:
Parent/Guardian Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Alternate Parent/Guard
ian Name, Phone Number, Email
Your answer
Students and parents new to the program are required to attend a confirmation orientation. Which date will you attend?
*
Sept. 7, 7pm (zoom)
Sept. 8, 7pm (zoom)
Continuing in confirmation program
Lay leaders are a crucial to our program, would you be interested in serving as a mentor?
Yes
No
Maybe, need more information
Other:
Clear selection
I consent to the use of my child/children's photo, video image or audio recording taken during Sunday School to be used by Bethlehem Lutheran Church as they see fit.
*
Yes
No
Finally, youth are carrying a lot these days. Anything in particular Pastor Paisley should know?
Your answer
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