Confirmation Grade 7th-9th

School Year 2018/2019
Grades 7,8 and 9. Registration Fee: $40 per child.

Child's Name * First Last
Birth Date * / MM / DD YYYY
Grade in School:
Child #2 Name First Last
Birth Date / MM / DD YYYY
Grade in School:
Child #3 Name First Last
Birth Date / MM / DD YYYY
Grade in School:
Additional Children:

Please list name, birth date and grade of any additional children you would lie to register.
Parent Name(s)
Home Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Member of Family of Christ? Yes No
Home Email
Mom Cell: - (###) - ### ####
Dad Cell
- (###) - ### ####
Emergency Contact * First Last
Emergency Contact Phone * - (###) - ### ####
Allergies * YES (if yes, please list below) No
List Allergies

Please list any allergies and the name of the child the allergy pertains to.
Family of Christ Lutheran Church has my permission to take photographs and/or video of my child(ren) participating in church activities, and to use those photos/videos for the purposes of promoting Family of Christ programs and ministries. * Yes No