Information Form

Full Name (required): Your Email (required):

Address City , State Zip

Phones: Home Cell Work

Birth date: Marital Status SingleMarriedDivorcedWidowed Wedding Anniversary

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?

How did you find out about Epiphany?

Members of Epiphany are expected to regularly attend worship services, give financially to support the ministry of the church, and be involved in ministry at Epiphany. Would you like to become a member? YesNo Previous Church Attended?

Can we publish your name, address, phone number and email in our Parish Directory? YesNo

Spouse (if applicable)

Full Name: Email:

Phones: Cell Work

Birth date:

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?

Children Under Age of 18
Child 1:

Full Name: Birth date: Current Grade:

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?

Child 2:

Full Name: Birth date: Current Grade:

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?

Child 3:

Full Name: Birth date: Current Grade:

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?

Child 4:

Full Name: Birth date: Current Grade:

Baptized? YesNoWish to be Date: Where?

Confirmed? YesNoWish to be Date: Where?