New Patient/New Member Form


Please fill out the following form.



Member Information #1

* First Name

* Middle Name

* Last Name

* Street

Street

* City

* State

* Zip

* Email

* Phone

Alt Phone

Employment

Hobbies

* Baptised
 Yes    No

* Confirmed
 Yes    No

* Include in Directory
 Yes    No

Member Information #2

First Name

Middle Name

Last Name

Street

Street

City

State

Zip

Email

Phone

Alt Phone

Employment

Hobbies

Baptised
 Yes    No

Confirmed
 Yes    No

Include in Directory
 Yes    No


Child Information (Child #1)

Child Name 1

Child Age 1

Child Birthdate 1

Child Baptised 1
 Yes    No

Child Confirmed 1
 Yes    No

Add Another Child


Talents

Please check all the interests for you, your spouse, and your family as we may have a few areas where your talents my be in need:

Talents
   Worship
   Mission and Community,
   Children and Youth
   Building and Grounds
   Membership Care
   Church Growth
   Stewardship and Finance
   Technology
   Food
   Staff Parish Relations
   Crafts
   Gardening
   History

Groups

Would you like information for any of our groups?


Groups
   Nursery
   Children's
   Youth
   Jr/Sr High
   Young Adults
   Parents
   Womens Group
   Men’s Group
   Seniors
   Quilting

Additional Information

Please use this area to let us know anything you would like to share or any questions. Please include a short Bio to share with the congregation in our monthly Newsletter.


Additional Information