Family Survey Form

All information is strictly confidential.

Personal Information

Last Name:

First Name:

Street Address:

City:

State:

Zip:

Subdivision:

Home Phone:

Cell Phone:

Work Phone:

Date of Birth: / /

Occupation:

Email Address:

Are you a member? Yes No

Gender:

Marital Status:

Spouse Information

Name of Spouse:

If Married, Anniversary Date: / /

Spouse's Cell Phone:

Spouse's Work Phone:

Spouse's Date of Birth: / /

Spouse's Occupation:

Spouse's Email Address:

Are you an adult living with your parents or other members of your family? Yes No

Are you a member of Christian Education? Yes No

If yes, name of class:

Are you a member of any church organization, or an appointed or elected officer? Yes No

If yes, please list all:

Children Information

Children living at home?

Miscellaneous

Can you give blood if necessary? Yes No

If yes, your blood type:

Can your spouse give blood if necessary? Yes No

If yes, your spouse's blood type:

What are your hobbies?

What areas of ministry in the church do you have an interest in being involved?