Our Lady of Fatima Catholic Church
105 N. La Esperanza
San Clemente, CA 92672

Confirmation Registration 2020-2021
Name:  
Cell #:  
e-mail:  
Student  Information
Parent/Guardian Information
Name:  
Cell #:  
e-mail:  
Last*
First*
Address:  
Number & Street*
City*
State*
Zip*
Home #:  
Name*:  
Relationship*::  
Phone*:
Emergency contact:
Relationship to Student*
Last
First
Relationship to Student
Name
Age
DOB
Sex
M/F
Grade
in Fall
Student Cell
Baptism
Y/N
1st
Comm.
Y/N
School
YEAR ONE
Program fee: $150  ($50 deposit kindly requested if fees not paid in full)

Grades 9-12    Sundays 6:00-8:00 PM
Name
Age
DOB
Sex
M/F
Grade
in Fall
Student Cell
Baptism
Y/N
1st
Comm.
Y/N
School
YEAR TWO
Program fee: $150 + Retreat fee: $100  Total: $250
($50 deposit kindly requested if fees not paid in full)

Grades 9-12    Sundays 6:00-8:00 PM
* Please list any allergies or medical conditions.  If 'none', enter if applicable.
* I authorize Our Lady of Fatima Church to obtain emergency medical treatment for my/our student/s, if I cannot be reached.
* I authorize Our Lady of Fatima Church to use pictures of my/our student/ss for church presentations, marketing, publicity, promotion and instruction.
* Name of person completing form:  
Student
E-mail
Student
E-mail
* Required
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YesNo