Registration Form

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:
17. Enter Your Email Address: *