Poinsettia Fundraiser

RED CREAM PINK MARBLE

PEPPERMINT JINGLE BELLS

Child Name *Please enter the child's full name
Child's Date of Birth *
Child's Grade *Please indicate what grade your child will be entering September 2017
Special Information Please indicate if your child has any allergies or special needs
Name of Person/s bringing child to Confirmation Class Please indicate who will be bringing your child to Confirmation Class other than yourself.
Parent/Guardian Name *
Parent/Guardian Home Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Parent/Guardian Phone *
Parent/Guardian Email *
Parent/Guardian Name *
Parent/Guardian Home Address (If Different)
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Parent/Guardian Phone
Email
I Agree *
Photographs may be taken throughout the year for church use only. This may include multimedia presentations in the service or for Confirmation purposes. Please acknowledge your permission.Yes, my child may be photographed