Register

Hello,

We're creating a database of all church members to organize them in a way that will help in planning and resource mobilisation. It is not mandatory that you give every piece of information but please have patience to give as much information as you can, because every field on this form is important.

Thank you.

Personal Information

Title (Mr., Mrs., Dr., Prof etc.):

Surname:

Other Names:

Date of Birth (e.g: June 20, 1980):

Upload Your Picture (Just Your Face):

I Am a Communicant (I take Communion):
YesNo

Phone Number:

Email Address:

Nationality:

Facebook Name:

Twitter Handle:

Postal Address:

Residential Address:

Residential Locality (e.g. Dansoman, Mamprobi etc.):

Residential Directions:

Father

Name:

Telephone Number:

Mother

Name:

Telephone Number:

Place of Birth:

Hometown:

I Have a Physical Challenge:
YesNo

Nature of Physical Challenge (Choose All That Apply)
HearingMobilityVisual

Church Information

Membership Status:
Already A MemberNot Yet A Member

Member Since (e.g June 20, 1980):

Transferred From:

Introduced by:
Name:
Phone Number:

Baptism

Date:

Place of Baptism

Officiant/Minister

Certificate Number

Confirmation

Date:

Place of Confirmation

Officiant/Minister

Certificate Number

Marital and Family

Marital Status:

If NOT single
Type of Marriage:
CivilCustomary

Date of Marriage:

Place of Marriage:

Officiant:

License No.:

Spouse Information

My Spouse is a Church Member

Spouse Name

Spouse Telephone Number

My Spouse is not a Church Member

Spouse Name

Spouse Telephone Number

Children

Children that are Church Members

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Children that are not Church Members

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Academic/Vocational Profile

Education Level:

Institution of Education:

Status of Education/Training:

Profession & Employment

Profession:

Employer:

Employment Status:

Contact Persons

Church Member
Name:

Phone Number:

Non Church Member
Name:

Phone Number:

Medical (For First Aid, etc.)

Blood Group:

Sickling Status:

Allergies

Medical Conditions

Departments, Groups, Committees And Special Roles

Please list all departments, groups, committees or special roles in which you have served and state the date on which you start and the date which you ended. eg. (Sunday School: 1 January 1998 to 31st December 2008). Seperate items with a comma or move to next line.