Saint Rose of Lima

Northborough, MA

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Confirmation
- Registration
  
  Confirmation / Life Teen
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Family Name REQUIRED Please fill out this field. Please enter valid data.
  
  Main Family Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Marital Status REQUIRED
  Select One
  Please fill out this field.
  
  Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Father's Email Please enter an email address.
  
  Father's Address (if different from Mother's) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Registration Information
  
  With Whom Does the Child/Children Live? REQUIRED
  Select One
  Please fill out this field.
  
  If you checked "Other" above, please list the guardian and their relationship to the child Please enter valid data.
  
  Emergency Contact Information
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Number of Children to be Registered for Confirmation (includes Life Teen) REQUIRED Please fill out this field.
  
  Child 1
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Are you registering this child, at St. Rose, for the first time?
  
  Name of church and location where child was baptized. Please enter valid data.
  
  If registering for the first time and your child was not baptized at St. Rose, a copy of his/her baptismal certificate must be sent to the office:
  
  St. Rose of Lima
  Religious Education Office
  PO BOX 685
  Northborough, MA 01532
  
  So we can better serve your family, please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Confirmation Registration (includes program and retreat)200.0
  
  Life Teen Registration is included.
  
  Child 2
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Are you registering this child, at St. Rose, for the first time?
  
  Name of church and location where child was baptized. Please enter valid data.
  
  If registering for the first time and your child was not baptized at St. Rose, a copy of his/her baptismal certificate must be sent to the office:
  
  St. Rose of Lima
  Religious Education Office
  PO BOX 685
  Northborough, MA 01532
  
  So we can better serve your family, please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Confirmation Registration (includes program and retreat)200.0
  
  Life Teen Registration is included.
  
  Child 3
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Are you registering this child, at St. Rose, for the first time?
  
  Name of church and location where child was baptized. Please enter valid data.
  
  If registering for the first time and your child was not baptized at St. Rose, a copy of his/her baptismal certificate must be sent to the office:
  
  St. Rose of Lima
  Religious Education Office
  PO BOX 685
  Northborough, MA 01532
  
  So we can better serve your family, please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Confirmation Registration (includes program and retreat)200.0
  
  Life Teen Registration is included.
  
  Child 4
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Are you registering this child, at St. Rose, for the first time?
  
  Name of church and location where child was baptized. Please enter valid data.
  
  If registering for the first time and your child was not baptized at St. Rose, a copy of his/her baptismal certificate must be sent to the office:
  
  St. Rose of Lima
  Religious Education Office
  PO BOX 685
  Northborough, MA 01532
  
  So we can better serve your family, please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Confirmation Registration (includes program and retreat)200.0
  
  Life Teen Registration is included.
  
  Child 5
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Phone Number Maximum 20 characters Please enter a phone number.
  
  Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending in 2025-2026 REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Are you registering this child, at St. Rose, for the first time?
  
  Name of church and location where child was baptized. Please enter valid data.
  
  If registering for the first time and your child was not baptized at St. Rose, a copy of his/her baptismal certificate must be sent to the office:
  
  St. Rose of Lima
  Religious Education Office
  PO BOX 685
  Northborough, MA 01532
  
  So we can better serve your family, please indicate any specific medical, academic, or behavioral needs of which we should be aware (allergies, IEP, etc...)
  
  Confirmation Registration (includes program and retreat)200.0
  
  Life Teen Registration is included.
  
  A photograph or video of your child(ren) participating in an event may be used on our website, social media, or in a newspaper story. . REQUIRED Please fill out this field.
  
  Volunteers Needed!
  
  Please consider how you can be a part of Life Teen.
  
  Please check areas of interest. Confirmation (Purpose) Teacher Life Teen Life Guard (Dinner Help) Life Teen Core Team Member Life Teen Band
  
  Other Gifts/Talents you would like to share with our program: Please enter valid data.
  
  If you would like to make an additional donation to help cover card processing fees and other expenses, please select an optional donation below.
  
  Optional Donation 3.0 – Thank You! 10.0 – Thank You! 25.0 – Thank You!
  
  We are endeavoring to make Life Teen open and free for all, while also creating a fun and exciting place and space for our teens. If you would like to make a free-will donation to Life Teen, to help defray our costs, it would be greatly appreciated.
  
  Life Teen Donation
  Your donation helps cover the cost of texts, scholarships, & other expenses for those in need.
  $ Please enter a positive decimal.
  
  Total:
  
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- Please complete the online registration form for Confirmation/Life Teen, then make your payment below.
- *At Saint Rose of Lima, we believe all children should have the opportunity to learn about God's great love for us. If you are experiencing financial difficulties, please contact Marisol Bermudez-Ellis to discuss an option that would best suit your family's needs.
- Contact Us
  
  Marisol Bermudez-Ellis
  
  Youth & Young Adult Minister
  
  508-393-2413 X6
  mbermudez-ellissaintroseoflima.com