Confirmation Registration

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Please Use This Form To Register Students In Grades 8-12 ONLY. All Others, Please Use the OCA Form To Register

CONFIRMATION REGISTRATION FORM

New Field:

Student's First Name

Student's Last Name

Address:

City/State

Zip Code

Email:

Phone:

Where Do You Attend School?

What Grade Are You In?

Mother's Full Name

Father 's Full Name

Church Of Baptism

St. Joseph Winter Haven

Other

Date Of Baptism

If Other, please provide name and address :

Church Of First Holy Communion

St. Joseph Winter Haven

Other

Date Of First Holy Communion

If Other, please provide name and Address

Emergency Contact Name

Emergency Contact Phone number

Do You Have A Sponsor?

Yes

Not Yet

If Yes, Please provide the name of your sponsor

Please Provide The Church Where Your Sponsor Attends

Do You Give Permission For Your Child's Image To Be Shared In The Media?

Yes, I give permission for my child's image to be shared in the media

NO, I do NOT want my child's photo to be used in the media

Circle Of Grace:

New Field:

Do You Give Your Permission For Your Child To Attend Circle Of Grace?

Yes, I give my permission for my child to attend Circle of Grace

NO, I do NOT want my child to attend Circle Of Grace

Thank you for registrating for

Confirmation Class.

REGISTRATION IS NOT COMPLETE UNTIL THE REGISTRATION IS PAID: $65/PER CHILD OR $130/PER FAMILY.

The office is now accepting Credit/Debit Card for your convenience.

Don't forget to bring a copy of your

Baptism Certificate and

First Holy Communion Certificate

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Our Location

532 Avenue M NW
Winter Haven, FL 33881

863-294-3144

Office Hours

Monday–Thursday: 8:00 am – 4:00 pm

Friday: 8:00 am – 3:00 pm

Closed For Lunch: Noon until 1 pm.

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