Youth Confirmation Registration

Confirmandi's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Which program the Confirmand will attend this year? Year One Year Two
Grade for 2025/2026 School Year 9th 10th 11th 12th
Name of the School Attending Please enter valid data.
Please List Any and All Allergies, Health Concerns, Special Learning Needs Teen May Have:
Mark All Sacraments Confirmandi has Received: REQUIRED Baptism First Reconciliation First Communion Please fill out this field.

Confirmandi's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Which program the Confirmand will attend this year? Year One Year Two
Grade for 2025/2026 School Year 9th 10th 11th 12th
Name of the School Attending Please enter valid data.
Please List Any and All Allergies, Health Concerns, Special Learning Needs Teen May Have:
Mark All Sacraments Confirmandi has Received: REQUIRED Baptism First Reconciliation First Communion Please fill out this field.

Parent/Guardian Information

Emergency Contacts

Emergency Contacts REQUIRED Please fill out this field.
Contact # 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Contact # 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Family Questions

Consent to Broadcast

Attendance at these events constitutes an agreement with the Catholic parishes and schools of St. Ambrose, St. Mary in Anderson, St. Mary in Alexandria parish and school and Holy Cross school use and distribution, now and in the future, or the attendees’ image or voice in photographs, videotapes, electronic reproductions, or audio-takes of the event. If you have questions or concerns, or wish for your photo to not be used, please contact (765) 644-8467.
Please Check the Box REQUIRED I have read and agree to the consent mentioned above and I understand that if I have any questions or have another preference, I will call the phone number provided. Please fill out this field.

Anderson-Alexandria Catholic Pastorate