New Member Enrollment

"Where Christ is the way and the Word is clear"

New Member Enrollment Form For Members Under 18
TODAY'S DATE

Month Day Year
Date
SERVICE TIME
SERVICE

Sunday Tuesday Communion Other
If (other) please describe
NAME
STREET ADDRESS
APT #
CITY
STATE
ZIP
PHONE: (Home)
(Cell Number)
EMAIL
example@example.com
DATE OF BIRTH

Month Day Year
Date
Under Age 18

Yes No
Under Age 18

Male Female
If you are under the age 18 please provide your parents name's and phone number and have one of them sign below:
PARENT/GUARDIAN NAME (PRINT)
PHONE NUMBER
PARENT/GUARDIAN NAME (SIGNATURE)

Clear
MEMBERSHIP CANDIDACY- (CHECK ONLY ONE IN THIS BOX)

New Christian (today) Recommitment Already a Christian Watchcare
Do you need Baptism?

Yes No
New Member Follow up Steward
Should be Empty: