New Member Family Profile Information

Your Information

Name*

First Last

I prefer to be called:

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Marital Status*

Wedding Anniversary

Employer*

if not applicable, please mark "n/a"

Occupation

Preferred Phone*

Secondary/Work Phone

Preferred Email*

Hobbies/Interests

What do you consider your "hometown"?*

Are you new to this area?*

Yes
No

If you attend a Sunday or Wednesday class, which one(s)?*

if not applicable, please indicate with "n/a"

Do you attend a Life Group? If yes, which one?*

if not applicable, please indicate with "n/a"

Would you like information about current Life Groups?*

Yes
No

I am interested in serving with

please mark all that apply

Preschool
Elementary
Middle School
High School
Other, please contact me

Do you or your family have any special needs that we should be aware of? If yes, please indicate those needs...

Spouse Information

(if applicable)

Name

First Last

I prefer to be called:

Date of Birth

Employer

if not applicable, please mark "n/a"

Occupation

Preferred Phone

Secondary/Work Phone

Preferred Email

Hobbies/Interests

What do you consider your "hometown"?

Are you new to this area?

Yes
No

If you attend a Sunday or Wednesday class, which one(s)?

if not applicable, please indicate with "n/a"

Do you attend a Life Group? If yes, which one?

if not applicable, please indicate with "n/a"

Would you like information about current Life Groups?

Yes
No

I am interested in serving with

please mark all that apply

Preschool
Elementary
Middle School
High School
Other, please contact me

Children

(if applicable)

Child #1's Name

First Last

Child #1's Date of Birth

Child #1's Gender

Male
Female

Child #1's Phone

(if different from parent's)

Child #1's Email

(if different from parent's)

Child #1's Grade

Child #1's School/College

Child #2's Name

First Last

Child #2's Date of Birth

Child #2's Gender

Male
Female

Child #2's Phone

(if different from parent's)

Child #2's Email

(if different from parent's)

Child #2's Grade

Child #2's School/College

Child #3's Name

First Last

Child #3's Date of Birth

Child #3's Gender

Male
Female

Child #3's Phone

(if different from parent's)

Child #3's Email

(if different from parent's)

Child #3's Grade

Child #3's School/College

Additional Children

please list child's name, date of birth, gender, phone #, email, grade & school for each additional child in the box below.

Does any of your information need to be kept confidential (not included on the CCH Membership app/directory)?*

YES, please answer below.
NO.

Please list all information that should be kept confidential in the CCH Membership app/directory:

(complete this field only if you answered YES to the previous question)

OPTIONAL: Please provide previous church and location if you wish for CCH to notify them of this new membership.

Name

This field is for validation purposes and should be left unchanged.