Holy Cross Orthodox Christian Church              2021 Online Membership Census Form
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Email *
Untitled Title
Untitled Title
Household information
Please fill out the following items for each member of your household.
Household information
Please fill out the following items for each member of your household.
Head of Household Date of Birth *
Head of Household: Date of Baptism or Christmation into the Orthodox Faith, name of priest and parish where the sacrament was performed. Orthodox patron saint name.
Spouse's Name (Last, First, MI) (Maiden name if applicable)
Spouse Date of Birth
Spouse: Date(s) of Baptism or Christmation into the Orthodox Faith (both spouses), name of priest and parish where the sacrament was performed. Orthodox patron saint name(s). If unknown, please give approximate place/date.
Youth Demographics
Please provide information about the children residing in your home so we can better serve their needs.
Name(s) of all children residing in the home, dates of birth, dates of Baptism, Orthodox patron saints.
School Information; please indicate where all children attend classes. (check all that apply)
If "other" please explain.
Extracurricular activities and interests of all children in the home. Example: Ballet, soccer, band, robotics team, etc...
Contact Information
Phone numbers, emails and address
Primary email *
Primary mailing address *
Primary and secondary (emergency) phone numbers *
Local Emengency Contacts and Next of Kin (names, email and phone numbers to be called in an emergency)
Number of years in Midland-Odessa area.
Number of years at Holy Cross Orthodox Church.
Biographical Information
Membership Status *
Marital Status
Clear selection
Occupation and Place of Employment for all adults in household.
Veteran Status for all individuals in household.
Clear selection
Branches of Service, Rank, Dates of Service for all individuals in household.
Certifications and Special Skills: Please list any special skills or areas of competency (personal or professional) within your household that may be of value to the church community. ie. certified teacher, American Red Cross training, instructor status, technical or medical training and experiance.
Are you or any member of your household a law enforcement officer, (local, state or federal) or employed by any department or agency of local, state or federal government.
Clear selection
If you are employed by any govenrmental entity, please explain giving agency, department and position. (ie. State of Texas, Department of Public Safety, Trooper)
Community and Youth Protection
We live in dangerous and uncertain times. Persons with legally required disclosures should be honest about their past for the safety of the parish, its children and liability protection. Persons serving in leadership positions with the parish may be required to undergo a background check.
Are you legally allowed to be around children under the age of 18 who are not members of your household?
Clear selection
Have you been convicted of any felony offense involving violence, domestic violence, stalking or terroristic threat?
Clear selection
Are you named in any protective order issued by a court.
Clear selection
Are you legally allowed to own or possess a firearm?
Clear selection
Are you required to register as a sex offender?
Clear selection
Current service or areas of interest in church ministry or service.
Check all that apply
Altar Server
Adult Education Teacher (please state qualifications and experience)
Youth Education Teacher (please state qualifications and experience)
Ordination to Holy Orders
Theological Studies
Clear selection
Parish Organizations Active or Interested in Joining
Financial Information
The parish depends upon the tithes and offerings of its membership to carry out the ministry and mission of the Orthodox Church in this community. We also need to know the struggles and challenges faced by our people. We cannot do so without your input. The information you provide is kept in the strictest confidence. Completion of this portion of the census is VOLUNTARY. YOU WILL NOT BE ASKED TO DISCLOSE YOUR INCOME. We thank you for your trust and support.
I am willing to voluntarily provide personal financial information to the parish so that my church community can plan and budget for the coming year.
Clear selection
Number of dependents in my household.
I or members of my household am/are a ________________.
Clear selection
Name of college or university where student(s) is/are enrolled. (for referral to Orthodox Campus Fellowships and scholarships)
I or members of my household are__________________? (check all that apply) This information helps the church understand the needs of its membership.
My household has a safe and stable housing situation.
Clear selection
My household has health insurance/benefits adequate for our needs and access to health care.
Clear selection
I need prayer and help with _________________________.            (mark all that apply)
My Financial Pledge to God
If unable to tithe, please indicate approximately the amount you can give each month.
Parish Directory (check all that apply)
Clear form
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