2018 Confirmation

February 4 - April 8 // Retreat: March 2-4 // Confirmation weekend: April 15

* required information


Student's First Name*:

Student's Middle Name*:

Student's Last Name*:



Birthdate mm/dd/yyyy*:




Student Cell Phone Number*:

Student Email*:

t-shirt size*:


Parent/Guardian Names:

Cell Phone:

Cell Phone:

Parent/Guardian Email*:

If you don’t currently receive them, would you like to receive EPIC’s bimonthly email newsletter? Yes No

Have your student been baptized? Yes No

Do you foresee any conflicts with your student’s schedule for our weekly gatherings, or for the Confirmation Retreat? If so, please explain.

Is there anything you think we should know about your child?

Medical Needs (medical/dietary/physical needs):

**I understand that all students must have a medical release form on file (pick up in EPIC office or download on our website).
Yes No

For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release Given
Photo/Video Release Denied

*RELEASE: Submitting this on-line form will be the equivalent of signing a paper registration form.
Yes, I agree

Name of Adult filling out this form*:

Date Electronically Signed mm/dd/yyyy*:

I plan to pay via*: Online Check
Due upon registration.

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