Middle School Confirmation

1Participant Information

2Education

3Parent/Guardian

4Medical Form

5Additional Information

6Photo/Video opportunities

7Payment

Grade Level(Required)

Participant Information(Required)

Participant First Name Participant Last Name

Preferred Name

Participant Email Address(Required)

Middle School Grade in 2023/2024 School Year(Required)

6th Grade

7th Grade

8th Grade

Gender(Required)

Prefer not to say

Date of Birth(Required)

MM slash DD slash YYYY

Parent/Guardian Name(Required)

Parent/Guardian Email Address(Required)

Parent/Guardian Home/Cell Phone(Required)

Parent/Guardian 2 Name

Parent/Guardian 2 Email Address

Parent/Guardian 2 Home/Cell Phone

Student's Home Address(Required)

Emergency Contact Name (if parent/guardian can't be reached)(Required)

Emergency Contact Primary Cell Phone #(Required)

Family Doctor Name(Required)

Phone(Required)

Hospital(Required)

Does your child have any allergies? (food or enviornmental) food tolerances or anything else they may encounter during programming/events?(Required)

Yes

Please list any allergies (including food tolerances)

Additional information you would like us to know (be sure to include any emotional, behavorial and/or special needs for participant)

Every participant is a unique learner and we do our best to meet the individual needs of participants. Would you like to be contacted by a staff member to help your participant be successful?(Required)

Yes

Has your child been baptized?(Required)

Yes

Has your child received a Spark Bible?(Required)

Yes

Has your child received First Communion?(Required)

Yes

Does your student have someone they would like in their small group?

I (We) grant to King of Kings Lutheran Church the right to take photographs in connection with children/youth education classes, summer programs, and any other Church sponsored event. I (We) authorize King of Kings Lutheran Church, its assignees and transferees to copyright, use, and publish the same in print and/or electronically, including the King of Kings website, social media, video and secure web-based photo sharing. I (We) agree that King of Kings Lutheran Church may use such photographs or videos within internal print publications/slides.

We prefer to pay in person.

True

6th Grade Confirmation

Price:

7th Grade Confirmation

Price:

8th Grade Confirmation

Price:

Quantity

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Total

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2023/2024 Confirmation Early Bird Registration

2023/2024 Middle School Road Through Confirmation EARLY BIRD