Confirmation Registration Form

Sacred Heart Catholic Church, LaPlata, Maryland

$0

Total
Registration fees for 7th & 8th grade: $200 total ($100 per student/year)

All fees are due at time of registration. No one will be denied enrollment in the Confirmation program due to the inability to pay. Please contact Father Larry Swink with any issues requiring special consideration.
Confirmation is a 2 year period of preparation normally spanning 7th and 8th grades. Attendance is especially important in order to prepare each child to receive this Sacrament, please schedule sports and extracurriculars accordingly. Your child needs to either attend a Catholic School for their religious education or register for Sacred Heart’s religious education program.
The following is a general schedule so that you can be familiar with what is expected of your child during Confirmation Prep:

Confirmation I
* Weekly Mass Attendance
* 6-7 Confirmation Prep meetings held once a month on Thursday evenings between September-April. Dates are available online.
* Retreat
* 4 parish service events & 4 parish community events by April/May 2019

Confirmation II
* Weekly Mass Attendance
* 6-7 Confirmation Prep meetings held once a month on Thursday evenings between September-April. Dates are available online.
* Retreat
* 4 parish service events & 4 parish community events by April/May 2019
* Sponsor & Saint Selection
* Confirmation Test
* Letter to the Bishop & Interview with the Pastor
We commit to the above described Confirmation Preparation Program for the 2018-19 school year
Parent/Guardian (draw your signature into the box below)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Confirmand (draw your signature into the box below)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Student's Name Student's Name First Last
Student resides with

Student resides with Mom Dad Mom and Dad Other
Gender

Gender Male Female
School attended
Grade (Fall 2018)

Grade (Fall 2018) 7th 8th
Program

Program Confirmation 1 Confirmation 2
Student's Email
Sacraments Received

Sacraments Received Baptism First Holy Communion Reconcilliation
Church of Baptism
Date of Baptism
Is Your Family an Active, Registered, and Contributing Family in the Parish?

Is Your Family an Active, Registered, and Contributing Family in the Parish? Yes No
Mother or Female Guardian
Name Name First Last
Religion
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email
Father or Male Guardian
Name Name First Last
Religion
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email
Emergency Contact Information

(Other than Parents/Guardians)
First Last
Relationship to Student
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Physician/Health Insurance Information
Primary Care Physician Primary Care Physician First Last
Phone Phone - ### - ### ####
Health Insurance Company
Policy Number
Name of Policy Holder Name of Policy Holder First Last
Current Medications/Medical Conditions/Allergies
List All Current Medical Conditions/Medical Conditions/Allergies
Permission and Medical Treatment Waiver

I hereby give my permission for him/her to attend Sacred Heart’s Confirmation Preparation Program or function and to be treated for a medical emergency in my absence while participating in the Confirmation Preparation Program. The Confirmation Program Director or Adult Supervisor may act as an agent in my absence. In case of an accident, I do not hold the Archdiocese of Washington, Sacred Heart La Plata Parish, its Staff, or Adult Chaperones responsible.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Photo Release Form

I hereby grant permission to Sacred Heart Catholic Church, La Plata, MD, and the Community Catholic Youth Ministry, to use my child’s photograph(s) in a photo display at the aforementioned church or on the Community Catholic Youth Ministry’s social media without payment or any other consideration.

I understand and agree that these photographs will become the property of Sacred Heart Catholic Church and the Community Catholic Youth Ministry and will not be returned. I hereby irrevocably authorize Sacred Heart Catholic Church and the Community Catholic Youth Ministry to edit, alter, copy, or exhibit my child’s image or likeness for purposes of the religious education program, youth ministry program, or for any other lawful purpose.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my own/my child’s likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph(s).

I hereby hold harmless and release and forever discharge Sacred Heart Catholic Church, the Community Catholic Youth Ministry, the Archdiocese of Washington, and their representatives from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf, my child’s behalf, or on behalf of my estate have or may have by reason of this authorization.
Please Check One

Please Check One I Consent I Do Not Consent
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Payment

We Accept V, MC, AE and D

Confirmation Registration Form

Confirmation Registration Form

$0

Total

Registration fees for 7th & 8th grade: $200 total ($100 per student/year)

The following is a general schedule so that you can be familiar with what is expected of your child during Confirmation Prep:

We commit to the above described Confirmation Preparation Program for the 2018-19 school year

Mother or Female Guardian

Father or Male Guardian

Emergency Contact Information

Physician/Health Insurance Information

Current Medications/Medical Conditions/Allergies

Permission and Medical Treatment Waiver

Photo Release Form

Payment

$`0`