Confirmation Registration Form

Today's Date(Required)

Parent/Guardian Information

Fathers Name(Required)

First Last

Fathers Religion(Required)

Mothers Name(Required)

First Last

Mothers Religion(Required)

Parent Satuts(Required)

Married

Separated

Divorced

Single

Guardians Name

First Last

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone Number(Required)

(optional) Phone number for Flocknote

Confirmation Sponsor Information

Sponsor Name(Required)

First Last

Sponsor Email(Required)

Has the Sponsor Form already been turned in? If not, a box will appear to upload it below.(Required)

Yes

No

Please have the Sponsor complete the sponsor form and upload here, if available

Max. file size: 10 MB.

* Pastor signature and Parish Seal Required. Please mail original to our church or drop off to the Parish Office.

Confirmation Saint Information

Confirmation Saint Chosen (Males choose male saints and females choose female saints)(Required)

Student Information

Returning student and was enrolled at SJE last year?(Required)

Yes

No

Confirmation Year 1 or Year 2?(Required)

Year 1

Year 2

Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Male

Female

Student Height(Required)

Shirt Size(Required)

Date of Baptism(Required)

Church of Baptism(Required)

Grade(Required)

Student Phone Number for Flocknote Text(Required)

Did you receive First Penance(Required)

Yes

No

Date of First Communion(Required)

Church of First Communion(Required)

Student Email(Required)

School Attending(Required)

Upload Baptism Certificate(Required)

Max. file size: 10 MB.

Upload First Communion Certificate(Required)

Max. file size: 10 MB.

Medical Authorization For Minor

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Medical Information(Required)

In case of illness or injury of the above student, reasonable effort will be made to contact the parent(s)/legal guardian(s)/emergency contact. In case of a medical emergency, 911 will be called. In the event that the parents/ legal guardian(s)/emergency contact cannot be notified or are not available, I (we) authorize parish, school, or other pertinent diocesan officials to consent to any x-ray examination, anesthetic, medical or surgical treatment, and/or hospital care, as determined to be necessary and appropriate by a licensed physician in the State of Florida. This authorization is valid for a period of 1 year from the date of execution.

Signature of Parent or Legal Guardian #1(Required)

Signature of Parent or Legal Guardian #2

Release of Liability and Indemnification Form for Trips, Programs and Events

I, the undersigned adult participant or parent/legal guardian of the above named minor participant (for myself and any named minor, our heirs, personal representatives, assigns and next of kin), request permission to participate in this particular event and/or the various field trips and other on and off site activities of the above school/parish/diocesan entity programs throughout the year. I understand that I will receive notice of scheduled field trips and events via an Event Notification Form, if applicable, and my signature consenting to my or my minor’s participation shall also indicate the inclusion of the terms of this Consent, Release of Liability and Indemnification Agreement to each trip or event. In consideration for the agreement by the school/parish/diocesan entity to permit my/minor’s participation, and intending to be legally bound, I, individually and on behalf of my youth, do hereby:

Release, discharge and covenant not to sue the Diocese of Venice in Florida and the Most Rev. Frank J. Dewane, Bishop of the Diocese of Venice, individually and as a corporation sole, the above Parish/School/Diocesan Entity; and their employees, clergy, agents and volunteers (hereinafter Releasees), from any claim, demand, action, or liability whatsoever on account of injury or loss to the person or property of minor child or adult in conjunction with said event, including travel to and from, whether caused by the negligence of the Releasees or otherwise, excluding acts of gross negligence or intentional misconduct;
Indemnify and hold harmless the Releasees and each of them from any loss, liability, damage or cost they may incur incident to adult or minor’s participation in the above event, whether caused in whole or part by the negligence of Releasees or otherwise;
I do further agree that school/parish/Diocesan entity/Diocese of Venice officials, agents, and/or employees have the right to terminate the participation of the above named for reasonable cause, as determined within the discretion of the event/trip leader. In such event, only the funds not actually used will be refunded. I will be responsible for any and all travel costs incurred to return the above named early from the event/trip.
I understand that throughout the year I/my minor may be informed via an Event and Trip Notification Form of activities apart from those on-site activities which are school/parish sponsored. If I do not give permission and sign the Event and Trip Notification Form, I am responsible for myself or the supervision of my minor at such event should I choose to attend independently of the program, although agents, employees and volunteers of the school/parish youth program/Diocesan entity/Diocese of Venice may also plan to be present at such events.
I understand that the school/parish/Diocesan entity youth programs may include sports (football, swimming, wrestling, etc.) and/or other risky activities (rafting, etc.). These sports activities involve certain risks including, but not limited to, travel to and from the site of the activity, severe physical contact, and the possible reckless conduct of other participants. These risks also include, but are not limited to, serious injury, potential for permanent paralysis, or death. The sporting activities may be conducted at sites that are at some distance from available medical assistance, and any equipment provided for protection may be inadequate in preventing serious injury.
I understand and assume the risks inherent with any extended event, which may involve certain risks beyond the reasonable control of the Parish/school/Diocesan entity and the Diocese of Venice, and their respective representatives, volunteers and agents. Such risks may include but not be limited to accidents, emergencies, exposure to nature and the elements, and/or negligence of the staff of the independent entity at the location of the event (not Parish or School staff). The Parish/school/Diocese or Diocesan entity disclaim any and all responsibility for any such risks by such independent vendors.
I am also aware that all reasonable care and supervision will be exercised by the Adult Chaperones to provide for the general well-being of my youth. However, I understand that there will be times when my youth is not directly supervised and it is impossible for the Adult Chaperones to supervise my youth every minute of every day while attending this program/event. I acknowledge placing my trust in my youth to adhere to proper standards of conduct and to follow the rules of the Group Leaders and Adult Chaperones, especially when not being directly supervised. I understand and assume the risks described above and those inherent with such a program/event.
I further represent that the above named is covered by accident and health insurance, and I agree to maintain coverage in full force and effect for the duration of the year. I have completed a Medical Authorization which is on file with the sponsoring school/parish/Diocesan entity in the event emergency medical care is required. I understand that the school/parish/Diocesan entity/Diocese of Venice provides no insurance which will cover my child in conjunction with future trips. I agree to full financial responsibility for any medical treatment provided to him/her.

Additional Family Members Participating

Click the “+” icon to the right of the box to add more

First Name

Last Name

Date of Birth

Parent / Guardian Signature(Required)

Authorization for Release and Use of Image in Photos, Video Files or Other Media

I, the undersigned adult participant or parent/legal guardian of the above named minor participant hereby grant to the above named School/Parish/Diocesan Entity the following irrevocable rights:

To use the name, photograph, picture, portrait, voice, appearance, likeness, performance (hereinafter collectively known as “image”) of the above named participant in connection with its educational, promotional, fund-raising activities, or for any other legitimate purpose;
The right to use, reproduce, publish, exhibit, distribute, and transmit the image of the above named participant individually or in conjunction with other images or printed matter in the production of brochures, slides, motion pictures, broadcasts (radio and television), audio or video files, recordings, still photography, CD-Rom and any other manner of media now known or later developed;
The right to use, reproduce, publish, exhibit, distribute, and transmit the image of the above named participant individually or in conjunction with other images or printed matter on the School/Parish/Diocesan’s entity Internet web site. No personal information such as home address or phone numbers will be published;
The right to record, reproduce, amplify, edit, and simulate the above named participant’s image and all sound effects produced; and
The right to copyright, in its own name, works that contain the image of above named participant; and
The right to assign the above-mentioned rights to third parties. I understand that the video files, still photos, or other media incorporating the image the above named participant will become the property of the School/Parish/Diocesan Entity. I hereby waive the right to inspect or approve the image or any finished materials that incorporate said image.

I understand and agree that no compensation will be provided, now or in the future, in connection with the use of the above named participant’s image, and nothing herein will create any obligation on the part of School/Parish/Diocesan Entity to make use of the rights or materials set forth herein.

I hereby release and forever discharge Frank J. Dewane, as Bishop of the Diocese of Venice, his successors in office, a corporation sole, The Specified Catholic School/Parish/Diocesan Entity, their agents, employees and assigns from any and all claims demand, rights, and causes of action of whatever kind that may arise from the use of above named participant’s image, including all claims for libel and invasion of privacy.

I hereby certify that I am the above named participant or the parent/legal guardian of the above referenced minor, and I give my consent, without reservation, to the above agreement on behalf of myself or said minor. This agreement shall be valid for a period of four years from the date hereof, unless revoked in writing.

Parent / Guardian Signature(Required)

Candidate Commitment

As a baptized Catholic, I am preparing for reception of the Sacrament of Confirmation, by which I will be more perfectly bound to the Catholic Church and enriched with a special strength of the Holy Spirit to spread and defend the Faith as a witness of Christ.

As a candidate for Confirmation, I promise the following:

I will approach my Confirmation journey with an open mind and an open heart.
I will attend and will fully participate in all Chosen sessions and activities.
I will be respectful of the leaders and facilitators of the program and show appreciation for their time and effort.
I will show respect to those in my class who are on the journey with me.
I will attend Mass every Sunday and on all holy days of obligation.
I will receive the Sacrament of Reconciliation before my Confirmation.
I will accept more responsibility in my family, parish, and community by putting my talents and gifts at the service of others.
I will commit to daily prayer, praying especially for growth in faith, hope, and love.

As I make these promises, I ask God to give me the grace to be open to his plans for my life-plans he reveals to me in prayer, in my talents and aspirations, and in the encouragement of those who know and love me. I place myself in the loving embrace of the Father, Son, and Holy Spirit in asking for help in fulfilling this commitment.

Name of Candidate(Required)

First Last

Signature of Candidate(Required)

Witness #1(Required)

Parent / Guardian

First Last

Witness #1 Signature(Required)

Our fees for each of the two consecutive confirmation instruction years is $100 per year per child. Thank you for the support of our program. Our fees do not cover all of our expenses, but help to offset our costs. If you have a financial need and are not able to pay the fees at this time, please contact Natalie at natalie@sjecc.com to learn about available scholarships.

Confirmation Reg

Price:

Total

Credit Card(Required)

Cardholder Name

Card Details

Name

This field is for validation purposes and should be left unchanged.

Confirmation Registration Form

Confirmation Registration 2025-2026

Parent/Guardian Information

Confirmation Sponsor Information

Confirmation Saint Information

Student Information

Medical Authorization For Minor

Release of Liability and Indemnification Form for Trips, Programs and Events

Authorization for Release and Use of Image in Photos, Video Files or Other Media

Candidate Commitment