Confirmation Registration

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  Joshua Hollcraft, Youth Ministry Coordinator - joshua.h@strosechurch.org
  
  Cost: $80 ($40 for each additional child)
  Necessary Certificates: Birth, Baptism, and First Communion
  Preparation for the Sacrament of Confirmation is a 2 year process. Once you submit this online form, registration is not completed until you turn in payment and documentation to the parish office.
  
  Costo: $80 ($40 para niños adicionales)
  Certificados necesarios: nacimiento, bautismo, y primera comunión
  La preparación para el Sacramento de la Confirmación es un proceso de 2 años. Una vez que envíe este formulario en línea, el registro no se completa hasta que entregue el pago y la documentación a la oficina parroquial.
  
  Are you or your family registered with St. Rose?¿Está usted o su familia registrados en Sta. Rosa? REQUIRED Yes | Si No Please fill out this field.
  
  Student | Estudiante
  
  Full Name | Nombre completo REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Género REQUIRED Male | Hombre Female | Mujer Please fill out this field.
  
  Date of Birth | Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School | Escuela REQUIRED Please fill out this field. Please enter valid data.
  
  Grade | Grado REQUIRED Please fill out this field. Please enter an integer (number).
  
  Home Address | Dirección de casa REQUIRED Please fill out this field. Please enter valid data.
  
  City & zip | Ciudad y código postal REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments | Sacramentos REQUIRED Baptism | Bautismo First Communion | Primera Comunión Please fill out this field.
  
  Church of Baptism | Iglesia de Bautismo REQUIRED Please fill out this field. Please enter valid data.
  
  Address of the Church of Baptism | Dirección de la Iglesia de Bautismo REQUIRED Please fill out this field. Please enter valid data.
  
  Parents | Padres
  
  Home Number | Teléfono de casa REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Father's Name | Nombre de padre Please enter valid data.
  
  Phone Number | Teléfono Maximum 20 characters Please enter a phone number.
  
  Mother's Name | Nombre de madre Please enter valid data.
  
  Phone Number | Teléfono Maximum 20 characters Please enter a phone number.
  
  Emergency Contact | Contacto de emergencia
  
  Name | Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship with student | Relación con el estudiante REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Medical Treatment and Consent
  In the event of an emergency, if I am unable to be contacted, I, the undersigned parent/legal guardian of the child named on this form, hereby give permission to the Diocese of Sacramento, parishes and schools within the Diocese, and their employees, representatives and adult volunteers to arrange for and authorize emergency medical, dental or surgical treatment for my child, as considered necessary by the attending physician. I wish to be advised prior to any further treatment by the hospital or doctor. I understand that the Diocese of Sacramento and St. Rose of Lima Catholic church do not assume responsibility for payment in an emergency situation. I hereby agree to bear all costs incurred as a result of the foregoing.
  
  Tratamiento médico y consentimiento de los padres/tutores
  En caso de una emergencia, si no puedo ser contactado, yo, el padre/tutor legal abajo firmante del niño nombrado en este formulario, doy permiso a la Diócesis de Sacramento, parroquias y escuelas dentro de la Diócesis, y sus empleados. , representantes y voluntarios adultos para coordinar y autorizar el tratamiento médico, dental o quirúrgico de emergencia para mi hijo, según lo considere necesario el médico tratante. Deseo ser informado antes de cualquier otro tratamiento por parte del hospital o médico. Entiendo que la Diócesis de Sacramento y la iglesia católica St. Rose of Lima no asumen la responsabilidad del pago en una situación de emergencia. Por la presente acepto asumir todos los costos incurridos como resultado de lo anterior.
  I Agree | Estoy de acuerdo Please select this field.
  
  Submit
  
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ST. ROSE OF LIMA CATHOLIC CHURCH

Roseville, CA

Confirmation Registration