Confirmation Form _______________ PRINT ONLY FORM __________________

Saint Mary’s Parish Church

CCD Religious Education Office

Dear parent or confirmand the following information is required (Please print). Return the completed form along with (if required) a Certificate of Baptism and First Communion together with Sponsor Eligibility Certificate to CCD Office, Immaculate Conception of the Blessed Virgin Mary Church, 1730 Fowler Avenue, Berwick, PA 18603-1462, telephone: (570) 759-9225.

Confirmand's Name: First: ____________________ Middle: ________ Last: _____________________

Date of Birth: Month: _____________Day:__________Year:___________

Street Address: _____________________________________________________________

Town - City: __________________________State: ___________________ Zip: __________

School: ____________________________ Home Parish: ___________________________

(Notice: If you are not from this Parish, you may NOT BE CONFIRMED here without permission in writing from the Pastor of your own parish.)

Date of Baptism: Month: ________________ Day: ____ Year: _____

Church of Baptism: __________________________________________________

Street Address: __________________________________________

Town - City: _____________________State: ____________ Zip: _________

(Notice: If the person to be confirmed (Confirmand) was Baptized in Saint Mary’s, no certificate need be submitted with this application, just indicate the date of Baptism as closely as you can. The Parish staff will consult our Parish records for the required information. If the person to be Confirmed was Not Baptized in this church, a certificate of Baptism must be submitted with this application.)

Saints Name to be taken at Confirmation: __________________________________________

Name of your Sponsor: ___________________________________________________________

Home Parish of your Sponsor: _____________________________________________________

(Notice: The Sponsor must be a good practicing Catholic. If your Sponsor is from this Parish, no testimonial letter (Certificate of Eligibility) is necessary. Saint Mary’s will consult our records for the necessary information. If your Sponsor is NOT from this Parish a testimonial letter from the Sponsor’s own Parish must be submitted with this application.)

Name of Father: First: ____________________Middle: _________Last: _______________________

Mother’s Maiden Name: First: ____________________Middle: ______Last: ____________________

Parent or Guardian: First: ____________________Middle: ______Last: _____________________

Street Address: __________________________________Apt. No.: _________

Town - city: _____________________State: ______________ Zip: _________

(Notice: No one may be Confirmed unless he/she has received sufficient instruction in Catholic teaching, especially with regard to the Sacrament of Confirmation. For this reason, all candidates for Confirmation must attend scheduled periods of instruction and practice faithfully.)