Family Information Form
 <  ERUCC Members Only >
( All Information submitted on this form will be kept in strict confidence )

(click here for a printable version of this form)

Please select one:     NEW     CHANGE 
 


FIRST NAME:**
MIDDLE INITIAL:
LAST NAME:**   DOB: / /
SPOUSE/PARTNER NAME:   DOB: / /

STREET ADDRESS: 
CITY:
STATE:
ZIP CODE:
HOME PHONE NUMBER: - -
CELL PHONE NUMBER: - -
E-MAIL ADDRESS:**
CHILDREN'S NAMES & AGES:

  DOB: / /   Grade:
  DOB: / /   Grade:
  DOB: / /   Grade:
  DOB: / /   Grade:
  DOB: / /   Grade:
  DOB: / /   Grade:
  

TIME/TALENT: 
(Please select those areas that you have an interest in being of assistance. Hold the CONTROL KEY down to select more than one item.)

ADDITIONAL NOTES:

Do you wish to receive regular E-mail communication from the church (i.e. Thursday Thoughts, Announcements, etc)?  YES     No   
** Required Fields
 
   

 

04/30/2011dth