CHURCH REGISTRY INFORMATION SHEET

Name (last, first, middle)________________________________________
Street________________________________________________________
City_____________________ State_______________ Zip_____________
Phone Numbers (Home)_________________(Business)_______________

Second Address
Street________________________________________________________
City_____________________ State_______________ Zip_____________
Phone Numbers (Home)_________________(Business)_______________

Birthdate________________City__________________State___________
Marital Status Single________Married________Anniversary_________
Occupation___________________________________________________
Special skills or talents__________________________________________

Baptism
Name of Church_______________________________________________
Address of Church_____________________________________________
Date___________________Rector ________________________________
Church Affiliation _____________________________________________

Confirmation
Name of Church_______________________________________________
Address of Church_____________________________________________
Date__________________Confirming Bishop_______________________
Church Affiliation_____________________________________________

How and when received into the Church:
By Baptism_________By Letter_________Received Date_____________

I do certify that the above information is accurate to the best of my knowledge.

Signature__________________________ Date____________