New Member Application Form
A congregation of The Lutheran-Church Missouri Synod
Head of Household
*
First Name
Middle Name
Last Name
Preferred Name (nickname)
Maiden Name (if applicable)
Gender
*
Male
Female
Home Phone (landline if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you presently a member of a church?
*
Yes
No
Name and address of current/previous church
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
*
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name and address of church where baptized
Confirmed?
*
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation Verse
Name and address of church where confirmed
Married?
*
Yes
No
Wedding Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer and/or Occupation
Spouse
Spouse
First Name
Middle Name
Last Name
Preferred name (nickname)
Maiden name (if applicable)
Gender
Male
Female
Cell phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Alternate Address (winter, lake home, etc.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you presently a member of a church?
Yes
No
Name and address of current/previous church
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name and address of church where baptized
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation Verse
Name and address of church where confirmed
Wedding Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer and/or Occupation
Children
How Many Children Live in Your Household?
0
1
2
3
4
5
Child #1
First Name
Middle Name
Last Name
Preferred name (nickname)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School (preschool - Grade 12)
Baptism Location (name and address)
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation verse
Name and address of church where confirmed
Child #2
First Name
Middle Name
Last Name
Preferred name (nickname)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School (preschool - Grade 12)
Baptism Location (name and address)
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation verse
Name and address of church where confirmed
Child #3
First Name
Middle Name
Last Name
Preferred name (nickname)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School (preschool - Grade 12)
Baptism Location (name and address)
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation verse
Name and address of church where confirmed
Child #4
First Name
Middle Name
Last Name
Preferred name (nickname)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School (preschool - Grade 12)
Baptism Location (name and address)
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation verse
Name and address of church where confirmed
Child #5
First Name
Middle Name
Last Name
Preferred name (nickname)
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Baptized?
Yes
No
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade in School (preschool - Grade 12)
Baptism Location (name and address)
Confirmed?
Yes
No
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirmation verse
Name and address of church where confirmed
I give permission to receive communications from St. John's (phone, email, text, other)
*
Yes
No
Please verify that you are human
*
Submit
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