CONFIRMATION REGISTRATION

FALL SEMESTER

Just complete this form, sign and drop it in the mail, or by the church office.   We look forward to having you be part of Confirmation 2011-12!

(Please PRINT legibly)

Youth’s Name: ____________________________________________________________

Goes By Name:  ________________________________

DOB: __________________       Grade:  _________        Gender:     M       F     (Please circle)

School:  ___________________________________________________

Address: ________________________________________________________________

City, State, Zip: ___________________________________________________________

Home Phone: _____________________________________

Parents’ Names: __________________________________________________________

Mom’s Cell Phone: _________________________________

Dad’s Cell Phone: __________________________________

Youth’s Cell Phone: ________________________________

Mom’s Email: ___________________________________________________________

Dad’s Email: ____________________________________________________________

Youth’s Email: __________________________________________________________

Has your Youth been Baptized? _______          Date of Baptism:  __________

*Youth T-Shirt Size   XS      S      M      L      XL    (Circle one)

_____  I have enclosed my $100.00 registration fee.  (This covers retreat fees, t-shirts and incidentals.)

_____  I am NOT interested in having my child confirmed at this time.  Please make sure you include your child’s name at the top and return this form to MPPC.  Thank you.

I support my youth going through Confirmation this Fall, and will assist them in the process.   

Parent Signature _______________________________________________

 If mailing this form, please put attention Stacy/Confirmation.(302 Hibben Street  Mt. Pleasant, SC 29464)

or send by email to  shanling@mppc.net

Thank you!