Confirmation Registration

Candidate Full Name:

Date of Birth:

City & State of Birth:

School:

Grade:

Best Candidate Contact Email:

Best Candidate Contact Cell Number:

Home Address:

City:

State:

Zip Code:

Div label

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Date of Baptism:

Church of Baptism:

City of Baptism:

State:

Div label

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Mother of Participant:

Mother's Maiden Name:

Mother's Cell Phone:

Mother's Email:

Father of Participant:

Father's Email:

Father's Cell Phone:

Additional Information: