Head-to-Heart On-line Registration Form

St. Paul Lutheran Church & School

7th 8th Grade

2010/2011 Head to Heart Program Registration Form

Select Program Time:

Sunday 10:15 H2H Program or Monday 7:00 p.m. H2H Program

Student Last Name:

First Name:

Middle Name:

Street Address:

City:

State:

Zip:

Home Phone:

Mobile:

Grade:

Name of School:

Birth Date:

Day: Year:

Baptismal Date:

Day: Year:

Church where you were Baptized:

Baptismal Church Address:

Mothers Name:

Fathers Name:

Student Lives With:

Both Parents Same Home Mother Father

Alternate Address:

Material Costs:

Student must purchase confirmation materials and bring a Bible and catechism to each class. You may also order a Bible and catechism from the church:

Confirmation Materials $50.00 (Required)

Catechism $10.00

NIV Hardcover Bible $10.00

NIV Study Bible $35.00

Your total is:

Payment Type:

Pay by Check Cash Youth Account Simply Giving [Link]

E-mail: (required to submit registration)

Please click the Submit button once - it may take a minute to receive a confirmation message.

Please print this page for your records before submitting form.