Family Name Street & Mailing Address Village / Township Zip Code Telephone Email Address Collection Envelopes Yes No Number of Adults 0 Adults 1 Adult 2 Adults 3 Adults Number of Children 0 Children 1 Child 2 Children 3 Children 4 Children 5 Children Remarks Please note any special skills or talents you may wish to share, any ministries or church organizations in which you may be interested, as well as any special needs to which we might respond (i.e. Homebound, marriage validation, etc.). Adults Adult #1 Last Name Maiden Name in () First Name Birthdate & Place Religion Baptism (Date/Church/Place) Married (Date/Church/Place) Adult #2 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Married (Date/Church/Place) Adult #3 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Married (Date/Church/Place) Children Child #1 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Communion (Date/Church/Place) Confirmation (Date/Church/Place) Child #2 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Communion (Date/Church/Place) Confirmation (Date/Church/Place) Child #3 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Communion (Date/Church/Place) Confirmation (Date/Church/Place) Child #4 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Communion (Date/Church/Place) Confirmation (Date/Church/Place) Child #5 Last Name First Name Birthdate & Place Religion Baptism (Date/Church/Place) Communion (Date/Church/Place) Confirmation (Date/Church/Place) You must enable JavaScript to submit this form