Confirmation Registration

Home » Youth » Confirmation Registration

Confirmation Registration

Questions? Kevin Malone, Coordinator of Confirmation, at email [email protected] for more information.

Teen Information

Full Legal Name *

First

Middle

Last

Nickname

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Teen Cell Phone *

Teen Email *

Age *

Date of Birth *

T-Shirt Size *

School Attending and Grade *

Extracurricular *

List any jobs, groups, or sports that you are involved in during the school year.

Any Sacraments Needed *

Parent/Guardian Information

Parent/Guardian Name *

First

Last

Parent/Guardian Phone Number *

Parent/Guardian Email *

Parent/Guardian Name

First

Last

Parent/Guardian Phone Number

Parent/Guardian Email

Masses and Church your Family Attends *

Are you interested in assisting during mass? *

If yes, please list the ministry *

Lector, Extraordinary Minister, Usher, Greeter, Choir

Parental Authorization

Is your child allowed to drive him/herself to church events? *

All Allergies *

List all Medications *

If needed can your child be given Motrin or Tylenol *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Doctor's Name *

First

Last

Doctor's Number *

Parent's Permission

I give permission for my child to take part in the Our Lady of Prompt Succor Confirmation Program activities on and off church grounds. In consideration of the opportunity for my child to participate and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do herby release, absolve indemnify, and agree to hold harmless the Diocese of Alexandria and Our Lady of Prompt Succor Church, its agents, employees and officers, the chaperones, leaders, organizers, sponsors, and persons transporting our child to and from these activities. Neither the Diocese of Alexandria and Our Lady of Prompt Succor Church, nor any of said persons shall be held financially responsible for any injury, illness, or death incurred as a direct or indirect result of this activity. I, the undersigned, have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance. In the event of an emergency and I cannot be contacted, I hereby authorize that emergency treatment may be administered.

Parent Signature *

Please type your name to sign.

Registration Fee *

Price: $30.00

Confirmation Registration