24757 Evergreen Mills RoadDulles, VA 20166(703) 661-5660Sunday Worship 9:30 & 11am
Youth Confirmation Registration 2012
Most of our communication is done via email. If you are not comfortable with this, please contact Katie Humphries (703-661-5660, ext. 102) with an alternate means of sharing information with you and your youth.
Student Information Full Name of Youth Prefers to be Called Grade School Email address Youth cell phone
T-shirt size Has your child been baptized? Yes No
Family InformationPlease provide the two primary family points of contact for your child. These persons will receive all communication regarding the confirmation process.
Person 1
Name
Relationship MotherFatherStep-MotherStep-FatherGrandparentOther
Email
Phone
Person 2
Volunteer
I can help drive to the retreat Yes No
I can help pick up from the retreat Yes No