TODAY'S DATE:    _______________

FAMILY NAME:     _______________________________________________________________________________

STREET ADDRESS:  _______________________________________________________________________________

P.O. BOX:        _______________________________________________________________________________

CITY:            ___________________________________  ZIP CODE: ________________________________

HOME PHONE:      (____) ____________________UNLISTED?  Y  N


When sending mail, address to (choose one)?
        MR./MRS.  MR.  MRS.  MISS  DR./MRS.  MR./DR.  OTHER: __________________


Registered at this Church:   Y    N        If YES, Envelope Number: _______________

====================================================PARENTS/GUARDIANS===================================================

RELATIONSHIP TO CHILD:  ___________________________________  RELATIONSHIP TO CHILD:  ___________________________________

NAME:      ________________________________________________  NAME:      ________________________________________________

BUSINESS:  ________________________________________________  BUSINESS:  ________________________________________________

BUS PHONE: (____) __________________________________         BUS PHONE: (____) __________________________________

RELIGION:  _________________________________________         RELIGION:  _________________________________________

MARITAL STATUS:   __________________________________         MARITAL STATUS:   __________________________________

When sending mail, address to (choose one)?                  When sending mail, address to (choose one)?

    MR.  MRS.  MS.  MISS  DR.  OTHER: ____________________       MR.  MRS.  MS.  MISS  DR.  OTHER: ____________________


I AM INTERESTED IN VOLUNTEERING FOR:                         I AM INTERESTED IN VOLUNTEERING FOR:

___________________________  ___________________________     ___________________________  ___________________________

___________________________  ___________________________     ___________________________  ___________________________


COMMENTS:   _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

=================================================EMERGENCY INFORMATION=================================================
In the event of an emergency, if you are unable to reach me, please contact the following:


     NAME:         ___________________________________________

     RELATIONSHIP: ___________________________________________

     ADDRESS:      ___________________________________________

     PHONE NUMBER: (____) ________________________

COMMENTS:   _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________

            _________________________________________________________________________________________________________