The Cathedral of St. Philip - Atlanta, GA

Youth Confirmation 2020

8th-grade youth and older are invited to go through the Confirmation program, which includes the retreat and small group classes. This year we will kick off Confirmation with a retreat during the second weekend in January, 24-26, at Camp Mikell in Toccoa, GA. There is a $50 fee for Confirmation.

Confirmation Small Groups will start on January 27.

(* Denotes Required Fields)

Confirmand Info
Full Name (first, middle, and last name): *
Date of Birth: *
City and State of Birth: *
Gender: *
School: *
Student Email: *
Student Cell Phone Number: *
Address: *
Date of Baptism:
Name of church where you were baptized:
Denomination of church where you were baptized:
Location of church where you were baptized (city, state):
Parent Information
Mother's Name: *
Mother's Cell Phone Number:
Father's Name:
Father's Email Address: *
Father's Cell Phone Number:
Members of The Cathedral of St. Philip?: *
Confirmation Retreat
The Confirmation Retreat is a integral part of the Confirmation program. It is a time for those going through the Confirmation Program to experience fellowship, explore their faith, and have fun! It is highly recommend that those wishing to go through the Confirmation Program attend this retreat.:
Will you be participating in the Confirmation Retreat January 24-26?: *
Do you have any dietary restrictions for meals during the retreat?: *
Please list any allergies and course of treatment/medication should the student have an allergic reaction: *
Please list and prescription medications, doses, and circumstances in which the medication should be taken: *
In the event that your student should need any over the counter medicine (such as Ibuprofen, Benadryl, etc.), do you give Cathedral of St. Philip's Youth Workers permission to administer the suggested dose?: *
Health Insurance Provider: *
Health Insurance ID Number: *
Health Insurance Group Number: *
Student's Primary Care Physician: *
Primary Care Physician Phone Number: *
T-shirt Size: *
Release Information
The Cathedral of St. Philip requests the right to take photographs/videos of you your child for lawful purposes, including publicity, news reporting, and web content: *
I agree with the following:: *
I do hereby authorize The Cathedral of St. Philip and its leaders as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act whether such diagnosis or treatment is rendered at the off if said physician or at the hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of their best judgment may deem advisable. This authorization shall remain effective until the parent(s) have indicated otherwise in writing to said agent(s). I shall indemnify, hold free and harmless, assume liability for, and defend The Cathedral of St. Philip, its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, attorneys’ fees, reasonable investigative and discovery costs, court costs, and all sums which The Cathedral of St. Philip, its agents, servants, employees, officers, and directors may pay or become obligated to pay on account of any, all and every demand for, claim or assertion of liability, or any claims or action founded thereon, arising or alleged to arisen out of my child’s use of real personal property belonging to The Cathedral of St. Philip, its agents, servants, employees, officers, and directors, or by any action or omission by my child. I hereby grant permission for my child to engage in the various activities sponsored by The Cathedral of St. Philip for its youth programs. This permission includes, but is not limited to, travel in automobiles, attendance at related group activities, and general participation in any and all activities sponsored by or associated with The Cathedral of St. Philip. Photo Release: I hereby grant to The Cathedral of St. Philip, and its representatives, permission to use photographs of my child in The Cathedral of St. Philip’s publications, press releases, on its website and through any other media that publicizes or promotes The Cathedral of St. Philip and I release the photographer, The Cathedral of St. Philip and their legal representatives from all claims relating to said photographs. I understand that a participant who does not abide by the rules of The Cathedral of St. Philip may be dismissed from the youth group or activity. Signature of participant and parent/guardian on this form waives and releases all volunteers from liability due to injury or illness incurred during activities or traveling to and from destinations. Participants are responsible for their own property. The Cathedral of St. Philip and the volunteers are not responsible. By typing your name below, you consent to the above.:
Name::
Confirmation Email
If you would like to receive an email confirming your registration, please put your email address here.: