First Lutheran Church Membership Form
Please complete as thoroughly as possible.
Household General Information
Overall family and primary contact information.
How would you like your mail addressed?
*
i.e. Mr & Mrs Smith, The Smith Family, The Smith-Johnson family, etc.
Household Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Landline/Cell
*
Please Select
Landline
Cell Phone
Listed/Unlisted
*
Please Select
Listed
Unlisted
Texting Option
*
Please Select
Yes
No
Cell Provider
Please Add Your Cell Provider even if the above number is a landline but a cell number will be provided under individuals in the family. Thank you.
Which phrase best describes your household?
*
Please Select
Children
Pets
Children & Pets
None of these
Please describe your household.
*
What would you like Pastor and the staff to know about your family?
Marital Status
*
Please Select
Single
Significant Other
Married
Divorced
Widow/Widower
Prefer not to answer.
Other/It's complicated.
Anniversary Date (if applicable)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you presently a member of another church?
*
Please Select
Yes
No
If "yes", what congregation do you presently belong?
Do you have any special needs for you or your loved ones?
*
i.e. ADA needs, allergies, emotional or behavioral needs, other.
How did you hear about First Lutheran Church?
*
Please Select
Family Member
Friend
Social Media
YouTube
Website
Other
Which service do you typically attend?
*
Please Select
8:00 am
10:30 am
no preference
This will help to plan the new member welcome.
Do you know anyone in the congregation?
*
Would you like the church newsletter mailed or emailed?
*
Please Select
Mailed
Emailed
Both
Would you like information about online giving?
*
Please Select
Yes
No
Please provide a short narrative to help us get to know you and your family better. We will include this in the welcome and newsletter.
*
Please include a family photo by uploading here or dropping one in the office.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Information
Please list someone we could contact if an emergency should occur during a church event.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Primary Communicator (Adult A)
Please fill out this personal information for the one who is the main communicator of the household.
Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Landline/Cell
*
Please Select
Landline
Cell Phone
Texting Option
*
Please Select
Yes
No
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Place of Confirmation
Place of Employment
Military Status
Please Select
Active Military
Retired Military
Reserves
N/A
Branch of Service
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Next
Additional Household Member(B-Adult 2)
Please fill out this personal information for each additional member of the household.
Name
Prefix
First Name
Middle Name
Last Name
Suffix
Email
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Phone Number
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Format: (000) 000-0000.
Landline/Cell
Please Select
Landline
Cell Phone
Texting Option
Please Select
Yes
No
Choose "Yes" only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Place of Confirmation
Place of Employment
Military Status
Please Select
Active Military
Retired Military
Reserves
N/A
Branch of Service
Back
Next
Additional Household Member(C-Child 1)
Please fill out this personal information for each additional member of the household.
Name
First Name
Middle Name
Last Name
Suffix
Email
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Cell Phone Number
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Format: (000) 000-0000.
Texting Option
Please Select
Yes
No
Choose "Yes" only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Place of Confirmation
School & Grade
Gladstone, Cameron Elementary, 2nd Grade
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Next
Additional Household Member(D-child 2)
Please fill out this personal information for each additional member of the household.
Name
First Name
Middle Name
Last Name
Suffix
Email
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Cell Phone Number
Provide only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Format: (000) 000-0000.
Texting Option
Please Select
Yes
No
Choose "Yes" only if person is over the age of 13 and has parental permission to receive communication from First Lutheran.
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Confirmation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Place of Confirmation
School & Grade
Gladstone, Cameron Elementary, 2nd Grade
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