Confirmation registration form

First English Lutheran Church CONFIRMATION REGISTRATION FORM
Student's first name:
Student's last name:
Nickname or preferred name:
Mother's name(s) (If multiple, list all:)
Father's name(s) (If multiple, list all:)
Other (guardians, relatives):
Parent/guardian marital status:	Married Single Separated Divorced Remarried Never married
Student lives primarily with:
Student's birth date:
Student's baptismal sponsors:
Name of school student is attending during 2008-09:
Activities student is involved in at school, community, church:
Each student can request one other young person they would like to be paired with for their small group. Requests will be honored as best as the staff is able to. Student would like to be paired with:
Other information you may feel is important to share with FELC staff and small-group leaders about this student or family. (i.e. parental situations, medical conditions, etc.)
Baptismal promises The following questions relate to the baptismal promises made at the font at your child’s baptism. Please answer honestly, so we can better know your family and child’s background. This will enable staff and small-group guides to better prepare you and your child for this stage of affirming those promises in their faith journey.
1. In what ways have your family and child been living among God’s faithful people?
2. In what ways have your family and child had the word of God and the Lord's Supper presented to them?
3. In what ways have your family and child learned about the following?	The Lord's Prayer: The Creed: Ten Commandments:
4. In what ways have the Holy Scripture been placed in your child's hands?
5. Describe how your family and child have been nurtured in the following:	Faith: Prayer:
6. Describe how your family and child have been taking care of the world God has created.
7. In what ways have your family and child been working toward justice and peace in the world?
Emergency Medical Information & Release Medical release form below must be completed to process registration!
Parent (Guardian) First Name
Parent (Guardian) Last Name
Address: City, State ZIP
E-mail (Note: If you wish to receive confirmation that your registration was processed, you must include your e-mail address in the box on the right.)
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Primary phone and/or cell phone
Physician's First and Last Name
Physician's Phone
Insurance carrier
Insurance Policy #
Confirmation student's First Name
Confirmation student's Last Name
Allergies
List current medications
Date of last tetanus shot
List health problems
FELC may use pictures of my child on its Web site and associated media and promotions.	Yes No
Parent (guardian) signature	By entering my name in the field below, I am submitting my signature.

Emergency Medical Information & Release Medical release form below must be completed to process registration!

Emergency Medical Information & Release
Medical release form below must be completed to process registration!