Church Directory Form

CHURCH DIRECTORY FORM

* Indicates required field

Family Last Name *

Home Number *

Family Main Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Would you like to receive the weekly church email? *

Yes No

Person #1 Name *

First

Last

Family Role *

Birth Date (i.e. August 21, 2014) YEAR IS OPTIONAL *

Wedding Anniversary (if applicable) *

Person #1 Cell Number *

Person #1 Email *

I give permission for my photo/video to appear on the church website, social media, other media forms and printed publications in association with Whitecourt Baptist Church. *

Yes No

PERSON #2

Person #2 Name *

First

Last

Family Role *

PERSON #3

Person #3 Name *

First

Last

Family Role *

Birth Date (i.e. August 21, 2014) YEAR IS OPTIONAL *

Person #2 Cell Number *

Person #3 Cell Number *

Person #2 Email *

Person #3 Email *

I (or parent/guardian if under 18) give permission for my photo/video to appear on the church website, social media, other media forms and printed publications in association with Whitecourt Baptist Church. *

Yes No

PERSON #4

Person #4 Name *

First

Last

Family Role *

Birth Date (i.e. August 21, 2014) YEAR IS OPTIONAL *

Person #4 Cell Number *

Person #4 Email *

Yes No

PERSON #5

Person #5 Name *

First

Last

Familly Role *

Birth Date (i.e. August 21, 2014) YEAR IS OPTIONAL *

Person #5 Cell Number *

Person #5 Email *

Yes No

Additional Family Members Information or Special Instructions (i.e. person #4 would also like to receive weekly emails) *