Confirmation 2017-2018
 
Confirmation 2017-2018
Your Email Address  * 
Student first name  * 
Student middle name  * 
Student last name  * 
Student’s mobile number
Student’s email address?
Name to be engraved on student’s Bible  * 
Mailing street address  * 
City  * 
Zip Code  * 
Mother’s full name  * 
Mother’s mobile number  * 
Mother’s email address  * 
Father’s full name  * 
Father’s mobile number  * 
Father’s email address  * 
Step-parent full name
Step parent mobile number
Step parent email address
If there are extenuating circumstances with a step parent, please share those here. (Note: this information will be kept in strict pastoral confidence.)
Student has been baptized?  * 
If yes, date and location/name of church?
Mother is a member of Liberty Crossings UMC?  * 
If not a LCUMC member, current church membership?
Father is a member of Liberty Crossings UMC?  * 
If not a LCUMC member, current church membership?
Student food/health allergies (If none, write "none.")  * 
Anything else that would be good to know about your child? (If none, write "none.")  * 
Student prescription medications taken. (Please write name, dosage, and instructions from bottle. This information is recorded for our overnight retreat. If none, write "none.") * 
Medical insurance provider  * 
Medical insurance policy/group number  * 
Are you or spouse interested in volunteering? (Trip Chaperones, Classroom Helper, Banquet Coordinator, Stole Knitter, and/or Driver)  * 
Total $
 
 
Powered by SiteOrganic Giving