Confirmation | East Union Church

Youth's Name:

Date of Birth:

Address

Youth's Cell Phone:

Youth's Email:

Parent/Guardian Name/s:

Address if other than above:

Parent's Cell Phone

Parent's Email

In case of emergency if above is not available, please notify:

Emergency Contact Cell Phone:

Emergency Contact Relationship to Youth:

Allergies, medications, special needs:

I give permission for my child to be taken to the nearest hospital emergency room in case of an emergency.

Yes

I give permission for my child to attend Confirmation Class events sponsored by East Union Presbyterian Church, Cheswick, PA for January-April 2026.

Yes

I allow photographs of my son or daughter to be used in our church or local media, such as website or social media.

Yes

Signature

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Date

Month

Day

Year

Confirmation 2026