Union-Congregational Church of Waupun Confirmation Registration Form:

1.
*

First Name:
2.
*

Middle Name:
3.
*

Last Name:
4.
*

Street:
5.
*

City:
6.
*

Zip:
7.
*

Telephone Number:
8.
*

Birthdate:
9.
*

Baptized

 (1 required)
Yes   No
10.
*

Parent/Gardian Names:
11.
*

Emergency Contact Name(s):
12.
*

Emergency Contact Phone Number(s):

We will be sending out reminder e-mails to students and parents to keep everyone informed of upcoming events and necessary updates. This will be our primary mode of communication, so please be sure to check your e-mail regularly. Please share your cell phone numbers as well.
13.

Student E-mail Address:
14.

Student Cell Phone Number:
15.

Parent(s)/Guardian(s) E-mail Address:
16.

Parent(s)/Guardian(s) Cell Phone Number:

* Enter Your Email Address: