EOORC (Online) Confirmation Program Registration Form

We are pleased to partner with GO Project's Alana Martin in hosting an online Confirmation Program for the Region.

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* 1. Confirmand's (Student) Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Name of Supporting Church/ Community of Faith:

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* 3. Supporting Minister's Contact information:

Name

Email Address

Phone Number

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* 4. Parent / Guardian Contact information:

Name

Email Address

Phone Number

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* 5. Does the student have a mentor they would like to be partnered with for the program?

Yes

No

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* 6. If Yes, Please provide the name and contact information for the mentor.

Name

Email Address

Phone Number

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* 7. All program materials will be emailed to participants, however please indicate if you will require a hardcopy of the program materials mailed to you:

Yes

No

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* 8. Please let us know if you have any health conditions or educational accommodations we need to be aware of to help support you better during the program?