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Peace Lutheran Church + Waunakee, WI
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Name #1 (First, Middle, Last) *
Cell Phone
Home Phone
Address (Including city/zip) *
Email Address
Date of birth *
MM
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DD
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YYYY
Have you been baptized?
Clear selection
If you were baptized, what was the date? (if known - month/year)
Have you been confirmed?
Clear selection
Occupation & Place of Employment (if applicable)
Work Phone
Name #2 (First, Middle, Last)
Cell Phone
Address (Including city/zip)
Email Address
Date of birth *
MM
/
DD
/
YYYY
Have you been baptized?
Clear selection
If you were baptized, what was the date? (if known - month/year)
Have you been confirmed?
Clear selection
Occupation & Place of Employment (if applicable)
Work Phone
What would you like the staff at Peace to know about your household?
Which words describe your family unit? *
Marriage Date (if applicable)
MM
/
DD
/
YYYY
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