Prince of Peace Lutheran Church

2023-24 PoP Confirmation Registration (Grades 6th - 9th)

Please register by Wednesday, 9/6/23! Parent/Student Orientation meeting is on Wednesday, 9/13 from 6:30 - 7:30 PM. Confirmation classes kickoff is on Wednesday, 9/20 from 6-7:05 PM, with a meal ahead of time at 5:30 PM in the Fellowship Hall.

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Please complete sections to the best of your ability. Items marked with an * are required. We ask that you register your youth annually for Confirmation (grades 6th - 9th), and a registration form for each individual youth participating needs to be completed. Thank you.

Parent/Student Orientation is in-person on Wednesday, 9/13 from 6:30 -7:30 PM. Classes begin in-person the following week on Wednesday, 9/20 from 6-7:05 PM, with a meal ahead of time at 5:30 PM in the Fellowship Hall.

PLEASE REGISTER BY WEDNESDAY, 9/6/23! You will receive an e-mail confirming Confirmation registration upon submission.

If you have any questions, please reach out to PoP Youth Ministry Coordinator, Barbara Ekern, at barbara@popappleton.org.

YOUTH SECTION: A registration form for each individual youth (grades 6th - 9th) participating in Confirmation needs to be completed.

Youth's Name: *


First Name	Last Name

Middle Name (please include if applicable):

Preferred Nickname (if applicable):

Primary Residence/Address: *


Address

Address Line 2

City	State	Zip Code

If alternate address also applies, please share here:

Birth Date: *

Has your youth been baptized?

Select one

Yes
No

Name of Current School attending (List 'Home' if home schooled): *

Grade for Confirmation Lessons (pick one) (grade entering this fall): *

Select one

Is Youth a PoP Member? (Note, membership is not required to participate in Confirmation)

Select one

Yes
No
They would be interested in receiving membership information

Please list other siblings also enrolling in Confirmation & grade as applicable:

PARENT/GUARDIAN SECTION

Parent/Guardian #1 Name: *


First Name	Last Name

Parent/Guardian #2 Name:


First Name	Last Name

Parent/Guardian Phone Number(s) (Please note if cell (C) or home landline (H)): *

Phone Number

Parent/Guardian Email Address(es) :

Email Address

Are Parents/Guardians members of Prince of Peace? (Note, membership is not required to participate in Confirmation)

Select one

Yes
No
I/We are interested in receiving membership information

Additional Emergency Contact if Parent/Guardian unavailable (Name/Phone #/Relationship 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. *

Select one

Yes
No

In the event a Parent/Guardian/Emergency Contact can not be reached, please provide current contact information for Primary Physician (name, location/address, phone number): *

Please indicate any food allergies or other medical restrictions/conditions we need to be aware of. If none, type "none": *

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 SECTION

Volunteer Opportunities - I am interested in being a Small Group Leader for our Confirmation Youth at Prince of Peace.

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

Weekly
Bi-weekly
Substitute

Volunteer Opportunities - I am interested in helping out with special events or service projects for Confirmation at Prince of Peace:

Select one

Yes
No
Maybe

Volunteer Opportunities - I am interested in being a Faith Mentor for Confirmation Youth at Prince of Peace:

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:

By submitting this form, I grant permission to Prince of Peace Lutheran Church to use my child's likeness/pictures/videos in church promotional materials & communications. I agree to contact Barbara or other PoP staff if I want to opt out from this.

Signature of a Parent/Guardian (Type in name to confirm registration of the above youth). *

Today's Date *

* required