Prince of Peace Lutheran Church
2019-20 Confirmation Class Registration
Please complete sections to the best of your ability, items marked with an * are required; if you have questions, please contact Brigetta at 739-5255. Please pre-register by Sept. 7th as classes begin September 12th
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YOUTH SECTION: Please use a separate form for each child you are registering
Student's Name *
Middle Name (please include if applicable):
Preferred Nickname (if applicable)
For 9th Gr. Students ONLY: To opt-in to our new Youth to Youth directory*, please add your student’s phone number here (*a new internal tool for our youth to use to send out relevant event info to their PoP peers.)
Primary Residence/Address *
Address Line 2
District of Columbia
Prince Edward Island
If alternate address also applies, please share here:
Birth Date *
Baptismal Date (& Church Location if not baptized at Prince of Peace)
Name of Current School Attending (List 'Home' if home schooled)
Grade for Confirmation Lessons (pick one) *
Do not know / have not attended here before
Is Youth a PoP Member? (Note, membership is not required to participate in Confirmation)
He/she would be interested in receiving membership information
Please list other siblings also enrolling in Confirmation & grade as applicable
Parent/Guardian Contact Information (can include both parents' first names in "first name" section, or if different last names, list one parent in first box and second parent in second box ) *
Parent/Guardian Phone Number(s) (Please note if cell (C) or home landline (H) by person) *
Parent/Guardian Email Address(es)
Are Parents/Guardians members of Prince of Peace? (Note, membership is not required to participate in FF)
I/We are interested in receiving membership information
Additional Emergency Contact if Parent/Guardian unavailable (Name/Phone #/Relation to youth)
In case of a medical emergency, I give the staff of Prince of Peace Lutheran Church permission to treat my child until a Parent/Guardian can be reached. *
In the event a parent/guardian/emergency contact can not be reached, please provide current contact information for Primary Physician & health insurance policy # with name of policy holder:
Please indicate any food allergies or other medical restrictions/conditions we need to be aware of:
Please use this space to list any special educational needs (learning challenges, behavioral concerns etc.) and/or additional information you feel is relevant for PoP Staff to be aware of:
Volunteer Opportunities - I am interested in being a small group leader for our Confirmation Youth at Prince of Peace.
Maybe- Would like more information
If you answered yest to being a small group leader, what is your preferred availability?
Volunteer Opportunities - I am interested in helping out with special events or service project for Confirmation at Prince of Peace.
Volunteer Opportunities - I am interested in being a Faith Mentor for Confirmation Youth at Prince of Peace.
VOLUNTEER INFORMATION: If you answered yes or maybe to being a small group leader, service project volunteer or Faith Mentor, please provide name and email below.
PHOTO RELEASE: I grant permission to Prince of Peace Lutheran Church and it's representatives to use my Youth's likeness/image in church promotional materials & communications (e.g. newsletter, bulletin boards, website, social media, videos etc.) *
Signature of a Parent/Guardian (Type in name to confirm registration of the above youth). *
Today's Date *
This form is generated and maintained by Prince of Peace Lutheran Church.
For refund (if applicable) and privacy policies please contact Prince of Peace Lutheran Church at