Youth Ministries

Name *

First

Middle

Last

Preferred Name

Pronouns *

Grade in the 2025-2026 School Year *

Gender *

Male
Female
Nonbinary
Choose not to specify

Birth Date *

School Attending *

Sports / Extracurricular Activities

Student's Email

Student's Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Parent/Guardian Contact *

First

Last

Primary Parent/Guardian Phone *

Primary Parent/Guardian Email *

Additional Parent/Guardian Contact

First

Last

Additional Parent/Guardian Phone

Additional Parent/Guardian Email

Communication *

I would like all electronic communication (including text or cell phone call) directed to a Parent/Guardian.
I grant permission for Nativity staff members to communicate directly with our student regarding Nativity events and activities.
YES, it is okay to use photos or video of my child for Nativity Church marketing.
NO, I do not want photos or video of my child used for Nativity Church marketing.

Does your student have any special needs? (food allergies, physical needs, cognitive or behavioral challenges, or family situations) Please describe:

Student's Service & Growth Experiences interests and/or already participate *

This is a not a commitment, just letting you know what you'd be interested in so we can reach out to you with upcoming opportunities.

There is a suggested payment of $50.00 for each Confirmation student, with a family maximum of $100. You may pay by check or by following the instructions after you submit your registration.

CONFIRMATION

High School