Life at the Well Ministries Membership Form

Name*

First NameLast Name

Date of Birth*

Date

Gender*

Marital Status*

Spouse's Name

Children's Name and Age

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Preferred Contact Method*

Have you accepted Jesus Christ as your Lord and Savior?*

YesNoUnsure

If yes, when?

Do you currently attend a church?*

YesNo

If yes, where?

Covenant Members

Individuals or families who consider the hub their primary spiritual home and place of covering. They are fully submitted to the hub’s leadership, vision, culture , and apostolic mission.

Commitments:

• Consistent attendance at hub gatherings and trainings

• Active service in at least one ministry or outreach team

• Financial partnership through tithes and offerings

• Regular prayer covering for the hub, its leaders, and members

• Upholding the hub’s values and representing it with integrity in the community

• Participation in discipleship, mentoring, and equipping sessions

Affiliate Partners

Leaders, ministers, and believers who remain active members in another church/ministry but connect with the hub for apostolic alignment, training, resources, and fellowship.

Commitments:

• Participation in hub events, trainings, and missions when available

• Financial partnership through designated offerings or sponsorships

• Prayer support for the hub and its leadership

• Agreement to operate in unity and honor toward the hub’s vision , mission , and culture and their home church

Are you interested in becoming a member of our church?*

YesNoConsidering

Are you interested in becoming an affiliate partner of our church?*

YesNoConsidering

Have you been baptized?*

YesNoConsidering

Would you like more information about baptism?*

YesNo

Please check the areas you are interested in serving:*

Prayer Request (Please list any specific prayer needs):

Name*

First NameLast Name

Relationship*

Phone Number*

Please enter a valid phone number.

Signature*

Membership Form/ Affiliate Partner

Contact Information

Spiritual Background

Ministry Involvement

Emergency Contact