Teen Confirmation Registration

Welcome to the St. Mel Teen Confirmation Program! Please fill out the form below to register your child for Confirmation. In order to complete the registration process, you will be asked to upload scanned copies of Baptismal and First Holy Communion certificates. If the certificate is not uploaded at the time of registration you will get a reminder from me to send them to me once you find them.

* If you are registering more than one child, please fill out a form for each child.

Student Information

Student's First Name *

Student's Last Name *

Student's Mobile Number *

Student's Email Address *

Student's Date of Birth *

Student's T-Shirt Size *

Select One

XS
S
M
L
XL
XXL
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Student's High School *

Grade Entering in Fall *

Highschool Freshman: 9th
Highschool Sophomore: 10th
Highschool Junior: 11th
Highschool Senior: 12th
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Gender *

Male
Female
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Student's Registration Year *

Confirmation Year 1
Confirmation Year 2
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Mailing Address *

City *

Postal Code *

Please list any physical, emotional, and/or learning disabilities in which we should be aware of to better serve you and your child.

Father's Information

Father's Full Name

Father's Religion

Father's Cell Phone Number

Father's Occupation

Father's Work Phone

Father's Email

Mother's Information

Mother's Full Name

Mother's Maiden Name

Mother's Religion

Mother's Cell Phone Number

Mother's Occupation

Mother's Work Phone

Mother's Email

Student Lives With *

Both Parents (full time)
50/50 (or shared time)
Mother Only
Father Only
Other
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If Living with a Step-Parent, Please Include Name and Phone Number

Sacramental History

In order to complete the registration process, you will be asked to turn in scanned copies of Baptismal and First Holy Communion certificates.

Please check which sacraments this student has ALREADY RECEIVED. *

Baptism

First Communion (Eucharist)

Confession

Student's Baptism Date

Student's Church & City of Baptism *

Student's First Communion Date

Student's Church & City of First Communion *

Student's Baptism Certificate

Student's First Communion Certificate

Virtus Permission Form

We at St. Mel are committed to your child’s safety and well-being. There are daily reports of child abuse, both sexual and other forms in our society. Therefore, we recognize how important it is to “empower” our children and young people with the knowledge and understanding of ways to keep themselves and others safe from potential harm.

The Empowering God's Children & Young People© Safety Program is provided by the Archdiocese of Los Angeles as an ongoing effort to educate children and young people through classroom lessons and activities on ways to maintain their own personal safety. It is based on catechetical principals to help them know they are loved by God and that He wants them to be healthy and safe

The Empowering God's Children & Young People© Safety Program will be presented to our students during the course of Confirmation. Parents will be notified at least 2 weeks prior to the lesson. The theme for the School Year 2024 – 2025 Safe Environment Training is focused on the important topic of Boundaries and Bullyin. The lessons include the VIRTUS® Introductory Video "Empowering God's Children," a variety of classroom activities, a Parent/Child Take-Home activity, and a "Catechetical Connection" to the Catechism of the Catholic Church to magnify God's desire for the happiness, health and safety of all children and young people.

If you would like additional information regarding “Empowering God's Children &Young People©" Safety Program, or if you would like to review the materials/videos, please feel free to contact Bryan Villegas at 818-340-6020 ext.1043 or you may visit the Safeguard the Children website at www.archla.org/safeguard

Virtus Options (Yes/No Answer) *

Yes, I want my child to participate in the Teaching Touching Safety Program
No, I do NOT want my child to participate in the Teaching Touching Safety Program
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Electronic Signature: Please Sign To Confirm Your Choice *

Clear

Photo, Audio, Electronic Media Release Form for Minors

I hereby grant permission for my child to be photographed and/or videotaped during Class Sessions and and Ministry activities and events. I further grant permission for the resulting photographs and/or videotaped footage to be edited, if necessary, and then published for the purpose of promoting Youth Ministry. I understand that my permission extends through the 2024-2025 years that my child (ren) are enrolled. I understand that my child may decline to be photographed and/or videotaped at any time.

Name & Voice Options *

Yes, I hereby grant permission for my child's name/voice to be used with media
No, I hereby decline to grant permission for my child's name/voice to be used with media
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Emergency Information

By filling out this form, you are authorizing the following adult(s) to be emergency contacts for your child. They will also be authorized pick up your student in the event of an emergency.

Family Health Insurance Company *

Family Health Insurance Number *

Student Allergies

Student Medications

Student Dietary Needs

Emergency Contact *

Payment

When you are finished submitting the registration form you will be redirected to Faith Direct to make your payment. Once Payment & Program Registration Forms are submitted, your child will be officially enrolled in the Teen Confirmation Program 2024-2025 at St. Mel.

Captcha

I Consent to Receive SMS Notifications for Session Reminders, Alerts & Occasional Marketing Communication from St. Mel Teen Confirmation. Message frequency varies. Message & data rates may apply. Text HELP to (818) 646-5066 for assistance. You can reply STOP to unsubscribe at any time.