Diocese of
Birmingham in Alabama

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Confirmand Registration Form

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  Today's Date: REQUIRED Please fill out this field. Please enter valid data.
  
  Confirmation Date: REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND FULL NAME: REQUIRED Please fill out this field. Please enter valid data.
  
  Confirmation Name (Patron Saint) REQUIRED Please fill out this field. Please enter valid data.
  
  DATE of BIRTH (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Age at time of Confirmation: REQUIRED Please fill out this field. Please enter valid data.
  
  DATE of BAPTISM (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  PLACE of BAPTISM - Church Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Baptism: if INTERNATIONAL please provide Address
  
  Place of Baptism - Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Baptism - City, State, Zip Code REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: Father's Full Name: REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: Mother's Full Name (include Maiden Name) REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: Home Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: City, State, Zip Code REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: Current Parish Name REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMAND: Current Parish Street Address Please enter valid data.
  
  CONFIRMAND: Current Parish City, State, Zip Code REQUIRED Please fill out this field. Please enter valid data.
  
  Pastor's Name: REQUIRED Please fill out this field. Please enter valid data.
  
  DRE Name and Email: REQUIRED Please fill out this field. Please enter valid data.
  
  Questions/Comments:
  
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