2024-2025 Teen Confirmation Registration

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  FAMILY INFORMATION
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Are you a registered parishioner at St. Denis? REQUIRED Please fill out this field.
  
  If you are registered parishioner, what is your envelope number? Please enter valid data.
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Telephone REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Email REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  Apt. # Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mother's Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name (First and Last Name on Birth Certificate) REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's First and Last Name REQUIRED
  Type 'none' if no Guardaian
  Please fill out this field. Please enter valid data.
  
  Guardian's Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Guardian's Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Check all who are Catholic: REQUIRED Father Mother Guardian Please fill out this field.
  
  Authorization for fair use of child(ren's) likeness.
  
  I hereby authorize the making of photographs, motion pictures, videotapes, recording, or other memorializing of said event and my child’s participation therein, and the publication and duplication or other use thereof. I hereby waive any rights to compensation or any right that I otherwise might have to limit if to control such making or use.
  
  Please type your First and Last Name and today's date in the field below to authorize. REQUIRED Please fill out this field. Please enter valid data.
  
  Medical and Emergency Contact Information
  
  Medical Insurance Organization REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Insurance Member # REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Insurance Expiration Date REQUIRED Please fill out this field. Please enter a date.
  
  Emergency Contact #1 First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact #1 Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact #1 Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact #1 Primary Email REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact #2 First Name Please enter valid data.
  
  Emergency Contact #2 Last Name Please enter valid data.
  
  Emergency Contact #2 Primary Phone Number Please enter valid data.
  
  Emergency Contact #2 Primary Email Please enter valid data.
  
  By typing your First and Last Name and today's date in the field below, you hereby authorize to release your child(ren) to the Emergency Contacts listed above.
  
  Authorization for release of child(ren) to Emergency Contact(s) REQUIRED Please fill out this field. Please enter valid data.
  
  Authorization to Consent to Diagnosis and Treatment; Waiver against damages to St. Denis
  
  Please read carefully.
  
  By typing your First and Last Name and today's date in the box below, you agree to the following:
  
  I / we are the legal guardians of the student named above and hereby authorize the authorities of St. Denis Catholic Community into whose care said participant has been entrusted, to consent to any x-ray examination, anesthetic,medical, or surgical diagnosis and treatment and hospital care to be rendered to said participant under provisions of the California Medical Practice Act; or to consent to any x-ray examination for dental or surgical diagnosis or treatment and hospital care to be rendered to said participant by a licensed dentist under the provisions of the California Dental Practice Act.
  
  It is understood that this authorization is given in advance of any specific diagnosis, treatment and hospital care being required, but it is given to provide authority and power on the part of the aforesaid agent(s); to give specific consent to any and all such diagnosis, judgment deem advisable. This authorization is given to the provisions of Section 25.B of the Civil Code of California. This authorization is to remain effective current year of enrollment unless sooner revoked in writing, delivered to said agent(s). I hereby waive any and all claims for damages against St. Denis Catholic Community and its authorized personnel of any kind of character which may arise out of the attendance of said participant and of its activities and orarising out of travel to and from said event(s).
  
  Parent/Legal Guardian Authorization REQUIRED Please fill out this field. Please enter valid data.
  
  Student Registration Information
  
  How many students do you wish you register? REQUIRED Please fill out this field.
  
  Student # 1
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Student # 2
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Student # 3
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Student # 4
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Student # 5
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Student # 6
  
  Registering for: REQUIRED Confirmation I Confirmation II Please fill out this field.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Middle Name (If any) Please enter valid data.
  
  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender of Student REQUIRED Please fill out this field.
  
  High School Grade as of Fall 2024 REQUIRED Please fill out this field.
  
  High School REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  ex. 01/01/2011
  Please fill out this field. Please enter a date.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Which Sacrament has this student received? (Check all that apply and submit proof at the Confirmation Office) REQUIRED Baptism First Communion No Baptism or Communion Please fill out this field.
  
  Please indicate any special needs (medical, learning and physical challenges, allergies, etc.) REQUIRED Please fill out this field.
  
  Extra-curricular Activities (please list all) REQUIRED Please fill out this field.
  
  T-shirt size REQUIRED Please fill out this field.
  
  (For Confirmation II Students Only) Student Height Please enter valid data.
  
  Empowering God’s Children and Young People© Safety Program
  
  The staff of St. Denis Confirmation Program and the Archdiocese of Los Angeles are committed to your child’s safety and well-being. We present the Empowering God’s Children and Young People© Safety Program to our students each year. Child sexual abuse continues to afflict our society. There is an ongoing need for children and young people to be empowered with the knowledge and tools to keep themselves and others safe from harm. This Archdiocesan Program includes a catechetical connection that highlights God’s love and desire for the health and safety of all children and young people.
  
  We will be presenting “Year 2: Boundaries and Bullying.” The goal of this lesson is to help young people identify and establish personal boundaries and recognize the signs and dangers of bullying. All young people must be taught the importance of protecting their boundaries to keep themselves and their peers safe from abuse. This lesson also identifies warning signs of online boundary and bullying violations. The program has proven to be invaluable in empowering young people to be vigilant in all their relationships.
  
  The program will be presented to our students during February 2025. Parents or guardians must give permission for their child(ren) to participate in this Safety Program by returning the completed permission slip below. If you would like additional information regarding the Safety Program or to review the materials, contact the Confirmation Office at (909) 861-7106 ext. 243.
  
  My signature below confirms that my child:
  
  Name of Child REQUIRED Please fill out this field. Please enter valid data.
  
  has my permission to participate in the Empowering God’s Children and Young People© Safety Program “Year 2: Boundaries and Bullying. I understand I must complete and return this Parent/Guardian Permission Form for each child participating by September 9, 2024.
  
  Please type your First and Last Name and Today's date in the box below to give permission to your child.
  
  Permission to participate in the Empowering God's Children and Young People Safety Program REQUIRED Please fill out this field. Please enter valid data.
  
  Confirmation Fees 2024-2025
  Confirmation I (for one student): $120 (registration) + $95 (retreat) = $215
  Confirmation II (for one student): $145 (registration) + $295 (retreat) = $440
  
  Confirmation I Registration REQUIRED 215.0 – Confirmation I 107.5 – Half-Payment (Full Payment due 12/1/2024) 195.0 – Registration for 2 or More Teens (Same Family; Enrolled in the Same Year) 0.0 – Not Registering for Confirmation I Please fill out this field.
  
  Confirmation I Registration REQUIRED 215.0 – Confirmation I 107.5 – Half-Payment (Full Payment due 12/1/2024) 195.0 – Registration for 2 or More Teens (Same Family; Enrolled in the Same Year) 0.0 – Not Registering for Confirmation I Please fill out this field.
  
  How many registrations for Confirmation I? Maximum 4 characters
  Enter the number of students you will be paying for this type of registration
  Please enter an integer (number) from 0 to 4.
  
  Confirmation II Registration REQUIRED 440.0 – Confirmation II 220.0 – Half-Payment (Full Payment due 12/1/2024) 420.0 – Registration for 2 or More Teens (Same Family; Enrolled in the Same Year) 0.0 – Not Registering for Confirmation II Please fill out this field.
  
  How many registrations for Confirmation II? Maximum 4 characters
  Enter the number of students you will be paying for this type of registration
  Please enter an integer (number) from 0 to 4.
  
  IMPORTANT: Before pressing Proceed to Payment, please go back and review the form to make sure everything is correct.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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- Enrollment Checklist:
  Teen Confirmation Registration Form
  Email [email protected] copies of Baptism and Eucharist certificates
  
  IMPORTANT: REGISTRATION WILL BE INCOMPLETE WITHOUT BAPTISM AND EUCHARIST CERTIFICATES. IF YOU ARE A RETURNING LEVEL II STUDENT, CONFIRM THAT OUR OFFICE HAS YOUR CERTIFICATES ON FILE.
  
  Back to Confirmation & Youth Ministry Program Details

2024-2025 Teen Confirmation Registration

FAMILY INFORMATION

Medical and Emergency Contact Information

Student Registration Information

Enrollment Checklist:

Teen Confirmation Registration Form

Email [email protected] copies of Baptism and Eucharist certificates

IMPORTANT: REGISTRATION WILL BE INCOMPLETE WITHOUT BAPTISM AND EUCHARIST CERTIFICATES. IF YOU ARE A RETURNING LEVEL II STUDENT, CONFIRM THAT OUR OFFICE HAS YOUR CERTIFICATES ON FILE.