Regency Baptist Church Family Directory

Thank you for taking the time to fill out this form!

Only one form is needed per family if everyone is living at the same address. Should you have a college/military student living away from home, please submit a new form just for them.

The information collected here is only for the church directory, church members and church staff. Your information will not be shared or sold to any other person or organization without your consent. Your security and privacy is important to us.

First Name

Last Name

Spouse's Name (if applicable)

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide us with at least one point of contact.

Home Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mobile Number

Please enter a valid phone number.Format: (000) 000-0000.

Spouse's Mobile Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Spouse's Email Address

example@example.com

Preferred Contact (We will need at least one point of contact)

Do you consent to be added to the church's text and/or email list? (The list will remain private and will not be shared with any third parties)

Birthday

MM-DD-YYYY

Spouse's Birthday

MM-DD-YYYY

Wedding Anniversary

MM-DD-YYYY

Children's Names and Birthdays (if applicable)

Ministries Your Family Are Involved In (check all that apply)

Ministries Your Family Are Interested In (check all that apply)

I give Regency Baptist Church permission to include the above information in the Church Directory.

Signature

CHURCH FAMILY DIRECTORY