Confirmation Program Registration

2022/2023 Confirmation Program Information

Welcome to the Confirmation Program for the Catholic Parishes of Adams & Cheshire! The program includes the students from St. John Paul II Parish in Adams and St. Mary of the Assumption Parish in Cheshire.

This year, students in grades 9, 10, & 11 will all be Confirmed together! Moving forward, Confirmation will take place at the end of 9th grade.

We need a head count of participating students before we place the order with our curriculum publishing company. If you intend to have your child(ren) Confirmed this year, please enter their information and then proceed to the bottom of the form to enter parent/guardian information and emergency contact details. The fee is $20/one child, $35/two children, $45/three or more children.

- Thank you!

Child #1

Please complete the following fields.

First Name

Last Name

Child's Nickname

Date of Birth

Gender

Male Female

Grade Level as of September 2022

School

Date, Name of Church, and Location of Baptism

Date, Name of Church, and Location of First Communion

Child #2

If entering a second child, please complete all fields.

First Name

Last Name

Child's Nickname (optional)

Date of Birth

Gender Male Female

Grade Level as of September 2022

School

Date, Name of Church, and Location of Baptism

Date, Name of Church, and Location of First Communion

ADDITIONAL CHILDREN MAY BE ENTERED AT THE BOTTOM OF THE FORM.

Parent/Guardian Information

Parent/Guardian Name

Address

Cell Phone

Home Phone

Work Phone

This address will receive a confirmation email

Are you a registered parishioner?

Yes No Unsure

Which Parish do you belong to?

St. John Paul II St. Mary of the Assumption

If you are not a parishioner, to which parish do you belong?

Secondary Parent/Guardian (please fill out this section if applicable)

Check if address is the same as above. same address

Address

Cell Phone

Home Phone

Work Phone

Emergency Contact Information

Please provide the name and phone number for TWO people to be called in the event that we cannot reach either parent/guardian.

Emergency Contact #1 Name

Emergency Contact #1 Phone Number

Emergency Contact #2 Name

Emergency Contact # 2 Phone Number

Please list others who are authorized to pick-up your child in addition to the parents and/or guardians and emergency contacts.

Please let us know if there are any other special circumstances regarding your child being picked up or dropped off.

PROCEED TO THE BOTTOM OF THE PAGE IF YOU ARE READY TO SUBMIT YOUR APPLICATION.

Child #3

If entering a third child, please complete all fields.

First Name

Last Name

Child's Nickname (optional)

Date of Birth

Gender Male Female

Grade Level as of September 2022

School

Date, Name of Church, and Location of Baptism

Date, Name of Church, and Location of First Communion

Child #4

If entering a fourth child, please fill in all fields.

First Name

Last Name

Child's Nickname (optional)

Date of Birth

Gender Male Female

Grade Level as of September 2022

School

Date, Name of Church, and Location of Baptism

Registration Fees & Payment

Registration Fees

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Confirmation Program Registration - 2022/2023

Description

Confirmation Program Registration - 2022/2023

Description

Please Fix the Following