Confirmation & Senior High Registration
Student Name
Birthdate
Grade
Text Phone Number
Parent/Guardian Name
Address
City/State/Zip
Phone Contact
Email Address
Emergency Contact
Emergency Contact Phone #
Check all that your youth will be participating in:
Confirmation 7-8
Youth Group 9-12
Appalachian Service Project registration is separate from this form. Please go to the ASP link
Medical or other information we should be aware of:
Please email me monthly newsletter:
Yes
No
I agree to allow my child's photograph to be taken and used for church only promotional materials such as bulletin boards and display cases, brochures, web, PR, etc. I understand that the church will not sell or give my child's picture to any other organization.
Choose one:
Yes
No
SUBMIT
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