2022-2023 Confirmation Registration
Sign up your 6th, 7th or 8th grade student for Confirmation at Bethany Lutheran Church.
First Name
*
Preferred Name
Last Name
*
School Grade
*
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
School Name
*
Mobile Number
*
Email Address
*
Home Address
*
Home Address Line 2
Home City
*
Home Zip Code
*
Home State
*
Parent's Name(s)
*
Parent/Guardian Mobile Phone
*
Household email
*
Alternate Phone Number
Emergency Contact (Other than Parent/Guardian) and Relation to Student
*
Emergency Contact Phone Number
*
Does your student have any allergies (food or otherwise) Bethany needs to be aware of? If yes, please list below.
*
Does your student have any special behavioral issues Bethany needs to be aware of? If so, please explain.
*
What do you hope your student gets out of Confirmation?
*
I give Bethany Lutheran permission to use photos of my child on church run social media pages.
*
Yes
No
My student is involved in outside activities that will likely take him/her out of Confirmation five or more times during the year.
*
Yes
No
I certify that all this information is correct to the best of my knowledge.
*
Yes
No
Submit