New Member Information
ST. JOHN THE BAPTIST CHURCH 313 East Second Street Jordan, MN 55352 952-492-2640 (fax) 952-492-5683
New Member Information HOUSEHOLD MAILING NAME:______________________________________________________ HOMEPHONE:_____________________________ (as you would like it to appear on church mailings, envelopes, etc.. Example: John & Jane Doe)
HOUSEHOLD STREET ADDRESS: _________________________________ CITY, STATE, ZIP _____________________________________________ DO YOU HAVE AN ALTERNATE MAILING ADDRESS: (maybe for winter months):
Yes or No
ALTERNATE MAILING ADDRESS: _____________________________________________________________________________________________ EFFECTIVE DATES FROM: _____/_____/______ to _____/_____/_____ EMAIL ADDRESS: _________________________________________________________________________________________________________ Permission to release phone number to other parishioners related to church matters? Yes or No
Do you prefer to donate electronically? Yes or No
Do you have talents/skills that you would be willing to offer if a need arose? (Ex. Carpentry, gardening, flower arranging, plumbing etc…) Please list: ________________________________________________________________________________________________________________________ Office Use only: Date Registered: _____/_____/_____ PDS: _____/_____/_____
Please contact the Church if any information changes. Male Last Name:
Female Adult Last Name:
First Name:
First Name:
Date of Birth:
Date of Birth:
Occupation:
Work #:
Maiden Name:
Occupation:
Religion:
Work #:
Religion:
Baptized Confirmed St. Johns School Alumnus? If you answer is yes, what year did you graduate?
Yes or No Yes or No Yes or No
Baptized: Confirmed: St. John’s School Alumnus? If you answer is yes, what year did you graduate?
Yes or No Yes or NO Yes or No
Marital Status Male Adult Marital Status: Single Married Widowed Separated Divorced If married, please indicate who officiated: Catholic Priest/Deacon Date of Marriage: Church
Marital Status: Minister
Female Adult Single Married Widowed Separated Divorced Civil Authority City/State:
Other Persons living in your household (children or adults) Name/First and Last
DOB
Sex
Sacraments (circle all received) Baptism Communion Reconciliation Confirmation Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Grade in School
Relationship to adults
New Member Information HOUSEHOLD MAILING NAME:______________________________________________________ HOMEPHONE:_____________________________ (as you would like it to appear on church mailings, envelopes, etc.. Example: John & Jane Doe)
HOUSEHOLD STREET ADDRESS: _________________________________ CITY, STATE, ZIP _____________________________________________ DO YOU HAVE AN ALTERNATE MAILING ADDRESS: (maybe for winter months):
Yes or No
ALTERNATE MAILING ADDRESS: _____________________________________________________________________________________________ EFFECTIVE DATES FROM: _____/_____/______ to _____/_____/_____ EMAIL ADDRESS: _________________________________________________________________________________________________________ Permission to release phone number to other parishioners related to church matters? Yes or No
Do you prefer to donate electronically? Yes or No
Do you have talents/skills that you would be willing to offer if a need arose? (Ex. Carpentry, gardening, flower arranging, plumbing etc…) Please list: ________________________________________________________________________________________________________________________ Office Use only: Date Registered: _____/_____/_____ PDS: _____/_____/_____
Please contact the Church if any information changes. Male Last Name:
Female Adult Last Name:
First Name:
First Name:
Date of Birth:
Date of Birth:
Occupation:
Work #:
Maiden Name:
Occupation:
Religion:
Work #:
Religion:
Baptized Confirmed St. Johns School Alumnus? If you answer is yes, what year did you graduate?
Yes or No Yes or No Yes or No
Baptized: Confirmed: St. John’s School Alumnus? If you answer is yes, what year did you graduate?
Yes or No Yes or NO Yes or No
Marital Status Male Adult Marital Status: Single Married Widowed Separated Divorced If married, please indicate who officiated: Catholic Priest/Deacon Date of Marriage: Church
Marital Status: Minister
Female Adult Single Married Widowed Separated Divorced Civil Authority City/State:
Other Persons living in your household (children or adults) Name/First and Last
DOB
Sex
Sacraments (circle all received) Baptism Communion Reconciliation Confirmation Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Baptism Communion
Reconciliation Confirmation
Grade in School
Relationship to adults
