Confirmation Registration *** Please download/read the Confirmation Booklet before proceeding with registration below. Family InformationFamily Last Name* Family Last Name How many children in grades 6th-8th are you registering?*Select1 Child - $2102 Children - $4203 Children - $6304 Children - $630Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone NumberPrimary Cell Phone NumberAdditional Cell Phone NumberCan we send you text messages?*YesNoPrimary Email* This email will be our primary means of communicationPrimary Email Verification* Please verify your primary emailFather's Full NameMother's Full NameEmergency Contact (other than Parent/Guardian)*Emergency Contact Primary Phone Number*Student 1 InformationStudent #1 Name* First Last Student #1 First Time Registrant?*YesNoIs this the first time you are enrolling this student in the St. James Religious Education Program?Please upload an electronic image of this child's Baptismal Certificate*You have indicated that this child is a first time registrant. In order to proceed, we need a copy of this child's baptismal certificate.Student #1 GenderMaleFemaleStudent #1 Grade*6th7th8thGrade for the 2020/2021 school yearStudent #1 SchoolStudent #1 Birth Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #1 Allergies/Pertinent Medical InformationHas Student #1 Received First Holy Communion?*YesNoStudent 2 InformationStudent #2 Name* First Last Student #2 First Time Registrant?*YesNoIs this the first time you are enrolling this student in the St. James Religious Education Program?Please upload an electronic image of this child's Baptismal Certificate*You have indicated that this child is a first time registrant. In order to proceed, we need a copy of this child's baptismal certificate.Student #2 Gender*MaleFemaleStudent #2 Grade*6th7th8thGrade for 2020-2021 school yearStudent #2 SchoolStudent #2 Birth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #2 Allergies/Pertinent Medical InformationHas Student #2 Received First Holy Communion?YesNoStudent 3 InformationStudent #3 Name* First Last Student #3 First Time Registrant?*YesNoIs this the first time you are enrolling this student in the St. James Religious Education Program?Please upload an electronic image of this child's Baptismal Certificate*You have indicated that this child is a first time registrant. In order to proceed, we need a copy of this child's baptismal certificate.Student #3 Gender*MaleFemaleStudent #3 Grade*6th7th8thGrade for 2020-2021 schoolStudent #3 SchoolStudent #3 Birth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #3 Allergies/Pertinent Medical InformationHas student #3 Received First Holy Communion?YesNoStudent 4 InformationStudent #4 Name* First Last Student #4 First Time Registrant?*YesNoIs this the first time you are enrolling this student in the St. James Religious Education Program?Please upload an electronic image of this child's Baptismal Certificate*You have indicated that this child is a first time registrant. In order to proceed, we need a copy of this child's baptismal certificate.Student #4 Gender*MaleFemaleStudent #4 Grade*6th7th8thGrade for 2020-2021 school yearStudent #4 SchoolStudent #4 Birth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #4 Allergies/Pertinent Medical InformationHas student #4 Received First Holy Communion?YesNoOpen Doors MinistryDoes your child have any special needs that require adaptive programming or a one-on-one mentor during the lessons?YESNOOpen Doors Ministry is here to support all families and ensure every child has access to faith formation in a peer setting. By voluntarily answering this question you are helping us provide an appropriate environment for all students. This information will be kept confidential. Please list the name(s) of any child(ren) who needs accommodations.A program coordinator will be in contact with you to learn more about your child to ensure s/he will receive the appropriate supports to be successful and happy in the St. James Religious Education program. Core Team InformationOur Core Team and ODM volunteers are the heart and soul of our confirmation program here at Saint James. Without the generosity and service of these men and women our program would not be able to happen. We are in need of more volunteers for our Core Team this year. With changes in the program from the past years this role has taken on a new approach from the traditional catechist role. The main role of our core team is to engage, relate, and instruct the youth through small group discussions. Therefore in order to ensure that all our volunteers are comfortable and equipped in doing this we will have a training session and orientation before the semester begins. This year we able to offer FREE FAMILY TUITION for all Core Team and Open Doors Mentors. Sacrament fee will be applicable to all Core Team/Mentors who have a child making the sacrament of First Reconciliation, First Holy Communion and/or Confirmation. If you would like more information please reach out to the middle school youth coordinator Matthew Lawson. firstname.lastname@example.org Are you interested in applying to be a Core Team Member or an Open Doors Mentor?*Yes, I am interestedNo, I am NOT interestedConfirmation Tuition and Emergency Consent Agreement2019-2020 Tuition Rates $210 one child $420 two children $630 three or more children (Maximum tuition per family $600) PLEASE NOTE CORE TEAM MEMBERS RECEIVE FREE FAMILY TUITION Previous year's tuition balances must be paid in full before 2019-2020 registration will be processed. The balance of ALL tuition for the 2019-20 school year is due by August 31st, 2019. Anyone registering after the June 30th deadline will be charged a non-refundable $50 late fee. No new registrations will be processed after October 1st, 2019 and no tuition refunds will be given after October 1st, 2019. Payments can be made now through August 31st 2019. All balances due no later than August 31, 2019 You can pay online with credit/debit card or you can drop off/mail in your tuition via check/cash in the Parish Office. No child will be turned away due to financial hardship. Tuition assistance applications are available. Please contact Barbara Krawczyk in the Business Office. EMERGENCY CONSENT: If the parents (or guardians) cannot be contacted in case of serious injury or illness, I authorize the Religious Education Program to take such emergency action as may be deemed necessary, including the transportation of the student to a hospital or medical center. As a parent (or guardian), I do herewith authorize the treatment by a qualified and licensed medical doctor of the following minor(s) in the event of a medical emergency that, in the opinion of the attending physician, may endanger his/her life, cause disfigurement or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. Total $0.00 $0.00 ****If you are applying to be a Catechist/Mentor please do not make a tuition payment until you have heard back from the RE office!!****Payment Code If you want to make installment payments type in "partial" in the Payment Code field.Payment Options*Full Payment NowCash/CheckI am interested in learning more about the tuition assistance program****If you are applying to be a Core Team Member please do not make a tuition payment until you have heard back from the RE office!!**** Balances due in full by Aug 31st 2019Payment Options*Partial Payment Now****If you are applying to be a Core Team Member please do not make a tuition payment until you have heard back from the RE office!!**** Balances due in full by Aug 31st 2018Partial Payment Amount Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name YOUR DIGITAL SIGNATURE BELOW SIGNIFIES YOUR ACCEPTANCE OF THIS TUITION AND EMERGENCY CONSENT AGREEMENT*Permission to use child(ren)'s image in Parish Media.*YesNoThis gives us permission to use your child's photo in the following media outlets....bulletin, website, parish run social media, and photo slideshowsEmailThis field is for validation purposes and should be left unchanged. 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