Student Name *

First Name

Last Name

Student Cell Phone

(###)

###

####

Student Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone Number *

(###)

###

####

Photo Release *

By signing up for Confirmation , you are acknowledging that sometimes pictures will be taken to be used in print and online publications, social media, worship slides, etc. We never label pictures with identifying information (name, age, grade, etc.).

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