St. Lucas UCC

Confirmation Registration Form



Planning for St. Lucas' 2017/18 Confirmation program is underway!  Please complete the form below if you have a student entering the 8th grade this year. Letters will soon be mailed to families of kids we know are entering 8th grade; however, if you do not receive a letter, we may not have your child’s date of birth in our database. If a letter is not received, or should you know of an 8th grader interested in our confirmation program this year, please complete the form below and a letter will be sent ASAP or you can pick one up in the Church Office.  

We look forward to sharing the Confirmation experience with all of you! And please, should you have any questions, feel free to contact any of us!

Amy Bush, Assistant Youth Ministries Coordinator,,
Kit Norton, Youth Ministries Coordinator,,
Rev. Eric Moeller, Associate Minister of Education and Mission,,
and Mr. Dan Coughlin, Confirmation Instructor,

 Learn more about Amy, Kit and Pastor Eric on our Staff page!


Throughout the program year, we will regularly utilize text messaging for Confirmation related reminders and information.  Your cell phone
number(s) will not be shared with 
anyone without your consent.


1. Confirmation Student's Full Name: *
First Name
Last Name
2. Name of Parent/Adult Contact: *
First Name
Last Name
3. Parent/Adult Contact's Home Address: *
Address Line 1
Address Line 2
Postal Code
4. Is this also the Student's Home Address? (If no, please enter the student's address below. If yes, skip to #6.)*
5. Please Provide the Student's Home Address ONLY IF DIFFERENT from the Parent/Adult Home Address Provided Above.
6. Parent/Adult Contact's Home Phone Number (Please enter N/A if you do not have a land-line phone.)*
7. Please provide the Student's Home Phone Number ONLY IF DIFFERENT than the Home Phone Provided Above.
8. Parent/Adult Contact's Email Address:*
9. Parent/Adult Contact's Cell Phone Number (including area code):*
10. Do We have Permission to Send Text Messages to this Number?*
11. Is the Parent/Adult Named Above KGCS (Keeping God's Children Safe) Certified?*
12. Please Provide Your Student's Cell Phone Number:
13. Do we Have Permission to Send Your Student Text Messages?*
14. Full Name of Parent/Adult #2 (if none/not applicable, please indicate with N/A and skip to #20): *
First Name
Last Name
15. If Different than the Home Phone Number, Provided Above, please provide A Home Telephone Number for Parent/Adult #2
16. 2nd Parent/Adult Email Address:
17. Cell Phone Number for 2nd Parent/Adult, including area code (if not applicable, please enter N/A)*
18. Do We Have Permission to Send Text Messages to this Cell Phone Number?*
19. Is this Parent/Adult KGCS Certified?*
20. Student's T-Shirt Size: *