Reconciliation Registration Form Student InformationFull Name* First Last Email Address* Enter Email Confirm Email Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Address* Street Address Address Line 2 City ZIP Code Parent/Guardian InformationFather's Full Name* First Last Mother's Full Name*(Include Maiden Name) First Maiden Name Last Family Contact E-mail* Enter Email Confirm Email (confirmation of form submission will be sent to this address)Parent Cell*Please provide the best number to contact.Family member(s) need Deaf Ministry signing at Confirmation Mass* Yes No Who needs assistance at Mass?*Additional Student InformationCandidate's Baptism Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Candidate was Baptized at Transfiguration* Yes No You may upload a copy of the Baptismal Certificate hereAccepted file types: doc, docx, jpg, jpeg, gif, png, pdf, odt, Max. file size: 10 MB.You must turn in a copy of his/her Baptismal Certificate. If your child received First Communion at Transfiguration, please email Karen to see if we have a copy of the Baptismal Certificate.Candidate will register for Religious Education classes for 2020-2021 school year.* Yes No Attends Catholic School Student completed Religious Education in 2019-20 at:* Parent PledgeParent Acknowledgement* I pledgeBy submitting this form, I pledge my efforts to continue to teach my child in the ways of faith in our home. I also pledge to make Religious Education available to my child, following Confirmation, through continuing enrollment and attendance in our ChrisTeen Youth Ministry Program or Catholic High School. The Confirmation preparation fee is $190 and covers cost of materials and Antioch retreat. ($175 if paid before October 7) Click payment icon below to make payment online OR you can bring payment to the ChrisTeen Office.Would you like an E-mail copy of the submission?* Yes No EmailThis field is for validation purposes and should be left unchanged.