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2016 - 2017 Confirmation Registration
Confirmation Registration 2016-2017
Confirmation Registration 2016-2017
Name of person completing form:
First Name
MI
Last Name
Primary Phone
Email of person completing this form (for email confirmation purposes)
Child's Name
First Name
MI
Last Name
Prefers to be called/Nickname
Grade for 2016 - 2017 School Year
10
11
12
Special Needs
Does this child have any special needs - such as physical handicaps, learning disabilities, behavioral needs, daily medications, medicinal allergies or dietary allergies?
Yes
No
Please identify special needs:
Parent/Guardian Information (including cell phone and email addresses)
Is the parent/guardian information the same for all children being registered in this household?
Yes
No
This child has different Parent/Guardian information than the rest of the children in the household
Mothers Maiden Name
Occasionally photos or videos may be taken at Religious Ed. I give permission for such photos/videos containing my child to be used for church purposes (St. James social media, email to parents, bulletin (hard copy and/or e-bulletin), newsletters, bulletin boards, press releases, etc.)..no names will be used in electronic correspondence.
Yes
No
Parent/Guardian volunteer opportunities:
Teacher
Substitute Teacher
Bake Sale
Driver to Social/Service Events
Chaperone for Social/Service Events
Fish Fry
Pancake Breakfast
Fundraising Events
10th Grade Retreat
Other
Thank you for registering your child.
Please review the above information for accuracy before submitting.
When you click the submit button, you will be taken to a page where you can register another child, or proceed to make payment.
Need assistance with this form?
