Youth Confirmation and Retreat Registration

Please use this form ONLY for grade 8 baptized students who attend The Basilica School of Saint Mary or another Catholic School.

Students in grade 8 and above who are attending a local Catholic school (such as St. Anslem’s Abbey, the Heights School, Oakcrest School, etc.), are members of the parish, and desire to be Confirmed at The Basilica of Saint Mary, are to provide the theology curriculum to the DRE with his/her registration.

This form is not for students enrolled in our children’s faith formation/CCD or homeschool CCD program because we collect this information and fees when you enroll in the program for year 8.

Step 1 of 7

Family Last Name(Required)

Family Address(Required)

Street Address Address Line 2 City State ZIP Code

Family Email(Required)

Family Phone(Required)

Are you a registered parishioner at the Basilica of Saint Mary(Required)

If you are not registered at any parish, we encourage you to do so; please contact the Basilica of Saint Mary's Receptionist for more information at (703)836-4100.

Parent/Guardian Information

Select Parents in Household(Required)

Parent/Guardian Marital Status(Required)

Father's Information

Father's Name(Required)

First Last

Father's Email(Required)

Father's Mobile Phone(Required)

Religion of Father(Required)

Religion of Father if Other than Roman Catholic(Required)

Mother's Information

Mother's Name(Required)

First Maiden Last Name

Mother's Email(Required)

Mother's Mobile Phone(Required)

Mother's Religion(Required)

Mother's Religion if Other than Roman Catholic(Required)

Legal Guardian Information

Name of Primary Guardian(Required)

First Last

Primary Guardian's Email(Required)

Primary Guardian's Mobile Phone(Required)

Religion of Primary Guardian(Required)

Religion of Primary Guardian if Other than Roman Catholic(Required)

Add Additional Guardian Information?(Required)

Yes

Additional Guardian Information

Name of Additional Guardian(Required)

First Last

Additional Guardian's Email(Required)

Additional Guardian's Mobile Phone(Required)

Religion of Additional Guardian(Required)

Religion of Additional Guardian if Other than Roman Catholic(Required)

Emergency Contact Information

Emergency Contact If Parent/Guardian(s) are unavailable(Required)

First Last

Relationship to Child(ren)(Required)

Emergency Contact Phone(Required)

Student Registration for the Sacrament of Confirmation and Retreat

Faith Formation Program(Required)

Medical Information and Liability

As the parent of the registered youth(s), I understand and acknowledge that participation in activities involves inherent risks of injury to my child. I agree to indemnify The Basilica of Saint Mary’s Catholic Church, its employees, staff, ministers, volunteers, and the Diocese of Arlington for any consequences or costs or expenses arising out of my child’s participation in the activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activity.

I further give my consent to that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor.

Medical Information and Liability Waiver(Required)

I agree

Photographs

A parent may withhold permission to have a child photographed and/or videotaped during activities related to Confirmation preparation and the Rite of Confirmation at The Basilica of Saint Mary’s.

If you do not want your child to be photographed and/or videotaped, please send notification in writing to the Basilica of St Mary's Office of Religious Education with the name of your child(ren) stating: DO NOT allow my child(ren) to be photographed or videotaped during Basilica of Saint Mary’s Confirmation Preparation and Rite of Confirmation.

Photographs taken during Confirmation activities may be selected for promotional use by The Basilica of Saint Mary’s staff.

Photograph Waiver(Required)

I agree

No, I do not agree; I will send notification in writing

Retreat Information and Permission

Youth candidates who desire and are preparing for the Sacrament of Confirmation are expected to attend and participate in a retreat. Below is some general information about the Confirmation Retreat. Who: Youth Candidates for Confirmation! What: Confirmation Retreat Why: To help the students grow closer to Christ and His Church and strive to be His witnesses. We will provide a lunch and allow for some fellowship and activities to build community. Additionally, the retreat will feature talks about holiness and how we are called to achieve it during our earthly life so that we can spend our eternal life in Heaven with God, Angels, and Saints. Students will have an opportunity to go to Confession and will participate in the Saturday Vigil Mass at 5:00 p.m. (families are welcome to join us as this will meet your Sunday Obligation to attend Mass. Students are to be signed out with a staff member before the student leaves). When: Doors open at 8:45 a.m. Retreat is 9:00 a.m. to 6:00 p.m. that includes Holy Mass. Following Mass, a parent/adult is to sign out the student.

How many children would you like to register for the Sacrament of Confirmation and Retreat?(Required)

1 Child

2 Children

3 Children

Confirmation Fee and Payment Information

Confirmation Fees include:

Retreat (materials, meals and stipend for missionaries)
Robes
Stipend for Bishop, MC, Ushers
Programs for the Rite of Confirmation
Reception or gifts
Certificates
Photography (professional pictures taken at the Rite of Confirmation along with individual pictures taken with the Bishop)

1st Child Fee

Price:

2nd Child Fee

Price:

3rd Child Fee

Price:

Total

Payment Method

Cash

Check

Credit Card

Request Confidential Financial Assistance

Cash payments will be accepted in person or may be sent to the Basilica of Saint Mary's parish office located in the Basilica of Saint Mary Lyceum (address listed below).

The Basilica of Saint Mary

Attn: Religious Education (Confirmation)

313 Duke Street

Alexandria, VA 22314

Please provide the Family name and children(s) names in the envelope.

Make checks payable to the Basilica of Saint Mary and mail to:

The Basilica of Saint Mary

Attn: Religious Education (Confirmation)

313 Duke Street

Alexandria, VA 22314

Please provide the Family name and children(s) names in the envelope. Thank you!

Financial hardship is not a barrier to participation in Faith Formation programing and no one will be denied the Sacraments due to lack of payment. We have generous benefactors who will cover the cost of your child's participation in Sacramental Preparation. If you need further assistance of any kind, please reach out to the parish for further information.

We may experience issues with the credit card payment due to plug in and update issues on our website. If the credit card payment option does not work when you are filling in this registration form, please select either cash or check as a form of payment. The Director of Religious Education will reach out to confirm how you wish to pay and will be able to take credit card payments over the phone. Please know we are working on the issue and bear with us as we sort it out.

Credit Card

Cardholder Name

Card Details

Youth Confirmation and Retreat Registration

Parent/Guardian Information

Father's Information

Mother's Information

Legal Guardian Information

Additional Guardian Information

Emergency Contact Information

Student Registration for the Sacrament of Confirmation and Retreat

Retreat Information and Permission

Child 1

Child 2

Child 3

Confirmation Fee and Payment Information