Confirmation Preparation

2024-2025 Confirmation Registration

Family Name (Last Name Only) Please enter valid data.

Family Email REQUIRED Please fill out this field. Please enter an email address.

Street Address 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.

Are you registered parishioner at Jesus the Divine Word Church? Yes No

If you checked NO please registerHERE

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact/Pick Up (Name&Cell) REQUIRED Please fill out this field. Please enter valid data.

Number of Children Registering REQUIRED Please fill out this field.
Child's Information 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.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Please check grade 2024-2025 school year? 8th grade 9th grade
- Does your child have an IEP or 504 in school? YES NO
- If yes, please let use know how to help them in a learning environment. Please enter valid data.
- Does your child have any allergies or medical conditions we need to be aware of? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Check the appropriate boxes) REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please list child's: date of baptism, name of church of baptism, city and state Please enter valid data.
Child's Information 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.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Please check grade 2024-2025 school year? 8th grade 9th grade
- Does your child have an IEP or 504 in school? YES NO
- If yes, please let use know how to help them in a learning environment. Please enter valid data.
- Does your child have any allergies or medical conditions we need to be aware of? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Check the appropriate boxes) REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please list child's: date of baptism, name of church of baptism, city and state Please enter valid data.
Child's Information 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Please check grade 2024-2025 school year? 8th grade 9th grade
- Does your child have an IEP or 504 in school? YES NO
- If yes, please let use know how to help them in a learning environment. Please enter valid data.
- Does your child have any allergies or medical conditions we need to be aware of? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Check the appropriate boxes) REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please list child's: date of baptism, name of church of baptism, city and state Please enter valid data.
Child's Information 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Please check grade 2024-2025 school year? 8th grade 9th grade
- Does your child have an IEP or 504 in school? YES NO
- If yes, please let use know how to help them in a learning environment. Please enter valid data.
- Does your child have any allergies or medical conditions we need to be aware of? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Check the appropriate boxes) REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please list child's: date of baptism, name of church of baptism, city and state Please enter valid data.
Child's Information 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Please check grade 2024-2025 school year? 8th grade 9th grade
- Does your child have an IEP or 504 in school? YES NO
- If yes, please let use know how to help them in a learning environment. Please enter valid data.
- Does your child have any allergies or medical conditions we need to be aware of? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Check the appropriate boxes) REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please list child's: date of baptism, name of church of baptism, city and state Please enter valid data.

Volunteer Information

Please consider volunteering - we have reoccurring needs and one time needs. Contact Jill

Please let us know how you would like to serve the children of our parish! Catechist Assistant Catechist Door and hall monitor Substitute Assistance as needed Cooking

Image Waiver

I give permission for pictures or videos of my child/ren engaged in activities relating to JDW to be posted in JDW publications or websites. Names will not be used without the express consent of parent or guardian. REQUIRED Please fill out this field.

Program Fees 2024-2025

Students REQUIRED 90.0 – 8th grade 175.0 – 9th grade Please fill out this field.

*Please contact Jill if you have a question about registration fees [email protected]