EmailMe Form - Adult Confirmation Registration Form

Today's Date *
MM / DD / YYYY
Name *
First Middle Last
Address *

Street Address City State / Province / Region Postal / Zip Code
Phone *
### - ### - ####
Email *
Are you registered at the Catholic Center? *
Yes
No
Baptismal Information
Baptismal Date *
MM / DD / YYYY
Name of Church *
City, State & Zip Code *
Attach a copy of your Baptismal certificate. (You can also mail a copy or simply bring it to the Center.)
Personal Information
Your Date of Birth *
MM / DD / YYYY
Birthplace City & State *
Father's Name *
First Last
Mother's Name *

First

Maiden

Last
Confirmation Information
The following information is not required; it is for future reference.
Confirmation Name
Sponsor Name
First Last
Is sponsor a member of the Catholic Center? (If not, your sponsor needs a letter from the parish stating he/she is in good standing & qualifies.)
Yes
No