Confession:

I, a poor sinner, acknowledge before you, my God and Creator, that I have terribly and in many ways sinned against you, not only outwardly, but much more with inward blindness, unbelief, doubts, impatience, pride, covetousness, envy, hatred, malice, and other sinful affections, as you my God, know well.  But I repent of these things, and heartily ask you for mercy, in the name of your beloved Son Jesus Christ.

Assurance of Pardon:

But he was pierced for our transgressions; he was crushed for our iniquities;upon him was the chastisement that brought us peace, and with his wounds we are healed.  All we like sheep have gone astray; we have turned—every one—to his own way; and the LORD has laid on him the iniquity of us all.

-Isaiah 53:5-6