HOUSEHOLD INFORMATION

* Required Fields

Head of Household First and Last Name *

Street/Mailing Address    City    State    Zip Code

Home Phone       List in church directory?    yes       no

Other Information or Comments
Also, if you would like information about a particular group, activity, or volunteer opportunity, please specify here.

ADULT HEADS OF HOUSEHOLD INFORMATION

Member 1

First and Last Name

Family Member Status (this is how you would like your family member "status" to be listed in the database) Husband Wife Male Head of Household Female Head of Household Male Adult Female Adult Widower Widow Son Daughter Other

Date of Birth - Please provide complete DOB, including the year. (We will use this info to contact you about special age-related events.)

Cell Phone

Email Address

If married, Date of Marriage

What groups or volunteer activities is this family member currently active in?

Member 2 (IF MEMBER 2 IS NOT AN ADULT, please go to the "Child and Youth Household Members" section.)

First and Last Name

Family Member Status (this is how you would like your family member "status" to be listed in the database) Husband Wife Male Head of Household Female Head of Household Male Adult Female Adult Widower Widow Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

What groups or volunteer activities is this family member currently active in?

If there are other ADULT members in your household, click here to add their information.

CHILD AND YOUTH HOUSEHOLD MEMBERS

Member 3 (child/youth)

First and Last Name

Family Member Status Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

Has this family member been baptized?
    no   |   yes...please provide details: Date   Location (Church Name, City & State)

Has this family member been confirmed?
    no    |   yes...please provide details: Date    Location (Church Name, City & State)

What groups or volunteer activities is this family member currently active in?

Member 4 (child/youth)

First and Last Name

Family Member Status Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

Has this family member been baptized?
    no   |   yes...please provide details: Date   Location (Church Name, City & State)

Has this family member been confirmed?
    no    |   yes...please provide details: Date    Location (Church Name, City & State)

What groups or volunteer activities is this family member currently active in?

Member 5 (child/youth)

First and Last Name

Family Member Status Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

Has this family member been baptized?
    no   |   yes...please provide details: Date   Location (Church Name, City & State)

Has this family member been confirmed?
    no    |   yes...please provide details: Date    Location (Church Name, City & State)

What groups or volunteer activities is this family member currently active in?

Member 6 (child/youth)

First and Last Name

Family Member Status Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

Has this family member been baptized?
    no   |   yes...please provide details: Date   Location (Church Name, City & State)

Has this family member been confirmed?
    no    |   yes...please provide details: Date    Location (Church Name, City & State)

What groups or volunteer activities is this family member currently active in?

Member 7 (child/youth)

First and Last Name

Family Member Status Son Daughter Other

Date of Birth - Please provide complete Date of Birth, including the year.

Cell Phone

Email Address

Has this family member been baptized?
    no   |   yes...please provide details: Date   Location (Church Name, City & State)

Has this family member been confirmed?
    no    |   yes...please provide details: Date    Location (Church Name, City & State)

What groups or volunteer activities is this family member currently active in?

OTHER ADULT HOUSEHOLD MEMBERS

Member 8 (adult)

First and Last Name

Family Member Status (this is how you would like your family member "status" to be listed in the database) Husband Wife Male Head of Household Female Head of Household Male Adult Female Adult Widower Widow Son Daughter Other

Date of Birth - Please provide complete DOB, including the year. (We will use this info to contact you about special age-related events.)

Cell Phone

Email Address

What groups or volunteer activities is this family member currently active in?

Member 9 (adult)

First and Last Name

Family Member Status (this is how you would like your family member "status" to be listed in the database) Husband Wife Male Head of Household Female Head of Household Male Adult Female Adult Widower Widow Son Daughter Other

Date of Birth - Please provide complete DOB, including the year. (We will use this info to contact you about special age-related events.)

Cell Phone

Email Address

What groups or volunteer activities is this family member currently active in?

May we send correspondence to you via email instead of U.S. mail? (This saves paper and postage.) *    yes     no   Please check yes or no.Please check only one.

*Your information will be kept confidential and used only for Mountain View purposes.