Prince of Peace Lutheran Church
2020-21 Confirmation Class Registration-
Please complete sections to the best of your ability, items marked with an * are required.Please contact Brigetta @ bwingender@popappleton.org with questions.Please pre-register by 9/15/20.Parent Orientation is 9/16/20 & Classes begin 9/23/20.
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YOUTH SECTION: Please use a separate form for each child you are registering
Student's Name *
required
First Name
Last Name
Middle Name (please include if applicable):
required
Preferred Nickname (if applicable)
required
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.)
required
Phone Number
Primary Residence/Address *
Address
Address Line 2
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Marshall Islands
Micronesia
Northern Marianas
Palau
Puerto Rico
Trust Territories
Virgin Islands
Armed Forces(AA)
Armed Forces(AE)
Armed Forces(AP)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territory
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
City
State
Zip Code
If alternate address also applies, please share here:
required
Birth Date *
required
Baptismal Date (& Church Location if not baptized at Prince of Peace)
required
Name of Current School Attending (List 'Home' if home schooled)
required
Grade for Confirmation Lessons (pick one) *
select one
Select one
6th
7th
8th
9th
Do not know / have not attended here before
Is Youth a PoP Member? (Note, membership is not required to participate in Confirmation)
select one
Select one
Yes
No
He/she would be interested in receiving membership information
Please list other siblings also enrolling in Confirmation & grade as applicable
required
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 ) *
required
First Name
Last Name
Parent/Guardian Phone Number(s) (Please note if cell (C) or home landline (H) by person) *
required
Phone Number
Parent/Guardian Email Address(es)
required
Email Address
Are Parents/Guardians members of Prince of Peace? (Note, membership is not required to participate in FF)
select one
Select one
Yes
No
I/We are interested in receiving membership information
Additional Emergency Contact if Parent/Guardian unavailable (Name/Phone #/Relation to youth)
required
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. *
select one
Select one
Yes
No
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:
required
Please indicate any food allergies or other medical restrictions/conditions we need to be aware of:
required
My child has access to the internet for virtual classtime:
select one
Select from list
Yes
No
I give permission for my child to participate in Zoom small groups:
select one
Select from list
Yes
No
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:
required
Volunteer Opportunities - I am interested in being a small group leader for our Confirmation Youth at Prince of Peace.
select one
Select one
Yes
No
Maybe- Would like more information
If you answered yes to being a small group leader, what is your preferred availability?
select one
Select one
weekly
bi-weekly
Substitute
Volunteer Opportunities - I am interested in helping out with special events or service project for Confirmation at Prince of Peace.
select one
Select one
Yes
No
Maybe
Volunteer Opportunities - I am interested in being a Faith Mentor for Confirmation Youth at Prince of Peace.
select one
Select one
Yes
No
Maybe
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.
required
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.) *
select one
Select one
Yes
No
Signature of a Parent/Guardian (Type in name to confirm registration of the above youth). *
required
Today's Date *
required
* required
