Confirmation Registration 2022 - Coral Gables Congregational United Church of Christ

Student Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone

Email

Enter Email Confirm Email

Date of Birth*

Birthplace*

School*

Grade (Fall of 2022)*

Hobbies and Interests

Baptized

If yes, where?

Medical Concerns We Should Know About

Student Digital Signature*

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Email*

Enter Email Confirm Email

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Email

Enter Email Confirm Email

Parent/Guardian Digital Signature*