2016-2017 Confirmation Registration

2016-2017 Confirmation Registration Please fill out both sides of this form, print, sign and return it to the church office.

Student Information

Last Name First Middle Initial Date of Birth

Address: Student Cell Phone

Student e-mail School District Student Attends

Baptized? Yes  No Received First Communion? Yes  No Date:______Where:______Date:______Where:______Will participate in Confirmation program Graduation Year:______ 6th grade  7th grade  8th grade  9th grade (Mentor Program)

Parent/Guardian Information Parent’s (Guardian’s) Name Member? Yes  No

Telephone: Home Cell E-mail

Available to volunteer? Yes  No If you are not a member of St. Mark’s, would you like to be contacted about joining St. Mark’s? Yes  No

Parent’s (Guardian’s) Name [If different than above] Member? Yes  No

Telephone: Home Cell E-mail

Available to volunteer? Yes  No If you are not a member of St. Mark’s, would you like to be contacted about joining St. Mark’s? Yes  No

Other Vital Information

Snacks may be served occasionally—please indicate if there are any dietary restrictions or allergies

Photos are occasionally taken at church events to be used by St. Mark’s in promotional material including the website. Please let us know if you prefer that your child not be included. Do not include in promotional photos

Registration Fee for Confirmation: $60.00 This covers the cost of program materials alongside special activities throughout the year. Confirmation Family Cap for fees $150 Fee included with registration. (Scholarships available) 2016-2017 Parent/Guardian Consent Form

Student’s name Date of Birth

Insurance Company Policy Number

Doctor’s Name Phone Number

Emergency contact #1 (Parent) Name Phone Relationship to student

Emergency contact #2 (Someone other than a parent) Name Phone Relationship to student

We, grant permission for ______to participate in all Confirmation ministry activities with St. Mark’s Lutheran Church in North St. Paul, MN for the 2016-2017 school year.

We believe that the participant is physically and mentally capable to participate in these events and understand that we will be responsible for picking up the above mentioned person if their behavior is disruptive, disrespectful or destructive.

We understand that the highest standards of safety will be upheld at these events, but in the case of an accident, we will assume the risk and responsibility of the above mentioned person is involved in an accident. The participant/ family will also be held responsible for accident or injury to any other party due to the participant’s behavior.

If we are not personally present at these events, in the case of emergency, St. Mark's is authorized on our behalf to arrange for such medical and hospital treatment as necessary for the health of the participant.

I authorize the participant to be transported by St. Mark's volunteers:

Parent (Guardian) ______Date ______

Please include any additional information (ie. physical challenges, learning challenges, social challenges) you feel would help us in providing the best experience for your student. All information will be kept confidential. You may also contact Pastor Ivy Huston directly by phone at 651-777-7451, ext 232, or at [email protected].

______Please attach a check for $60 for each student (payable to St. Mark’s, please put Confirmation 2016-2017 in the memo) with this registration form when you return it to the church office as soon as possible.