gFree Directory Form

1
Full Name* This field is required.
Mr.
Mr.
Mrs.
Ms.
Dr.
Prefix
First Name
Middle Name
Last Name
Suffix
2
Preferred NamePlease tell us what you would like us to call you.
3
Address* This field is required.
Street Address
Street Address Line 2
City
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Please Select
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Please Select
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Other
Country
4
Primary Phone Number* This field is required.
5
Alternate Phone Number
6
E-mail
example@example.com
7
Your Birthday* This field is required.
Date
Month
Day
Year
8
Additional Adult Name
First Name
Last Name
9
Relation to the Head of Household
Spouse
Sibling
Roommate
Parent
Child
Other
10
Primary Number
11
Alternate number
12
Additional Adult E-mail
example@example.com
13
Additional Adult Birthday
Date
Month
Day
Year
14
Name of Child #1: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
15
Name of Child #2: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
16
Name of Child #3: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
17
Name of Child #4: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
18
Name of Child #5: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
19
Name of Child #6: First Name     Last Name
Prefers to be called:
Date of Birth:      Date
Has this child been baptized?    YES     NO
List allergies or special needs (if any).

Identify talents, interests, hobbies, etc.
20

We'd like to upload photographs of our families to our system to help us better serve you. You may take a selfie of your family or attach a photo via one of the following options. Feel free to email your photo to wecare@peacefulrest.com.
21
Take a Photo - Selfie!Usable with computers and cell phones.
22
Upload A Photo of Yourself or FamilyFiles larger than 4.9 MB should be emailed to wecare@peacefulrest.com.
Drag and drop files here
Select files to upload
Max. file size: 4.9MB
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