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SPOUSE:
Title:   ♦ Dr.     ♦ Miss    ♦ Mr.     ♦ Mrs.    ♦ Rev.     ♦ Other: _________________________________
First Name:
  Middle Initial
Last Name:
  Nickname:
Maiden Name:
     
Baptized: ♦ YES    ♦ NO   Baptism Date:
Confirmed: ♦ YES    ♦ NO   Confirmation Date:
Date of Birth:
  ♦ MALE     ♦ FEMALE
Wedding Date:
  Spouse's Name:
Employer:
Occupation Title:
Work Phone:
  May we contact you at this number?     ♦ YES    ♦ NO
Is this person joining DLC?    ♦ YES    ♦ NO      
Current Church Membership at: (Name, City, State)  
Church Background:  
Father's First Name:
  Father's Last Name:
Mother's First Name:
  Mother's Last Name:
1ST CHILD:
First Name:
  Middle Initial
Last Name:
  Nickname:
Baptized: ♦ YES    ♦ NO   Baptism Date:
Confirmed: ♦ YES    ♦ NO   Confirmation Date:
Date of Birth:
  ♦ MALE     ♦ FEMALE
Is this person joining DLC?    ♦ YES    ♦ NO      
Father's First Name:
  Father's Last Name:
Mother's First Name:
  Mother's Last Name:
Current School:
 
Current Grade :
2ND CHILD:
First Name:
  Middle Initial
Last Name:
  Nickname:
Baptized: ♦ YES    ♦ NO   Baptism Date:
Confirmed: ♦ YES    ♦ NO   Confirmation Date:
Date of Birth:
  ♦ MALE     ♦ FEMALE
Is this person joining DLC?    ♦ YES    ♦ NO      
Father's First Name:
  Father's Last Name:
Mother's First Name:
  Mother's Last Name:
Current School:
 
Current Grade :
3RD CHILD :
First Name:
  Middle Initial
Last Name:
  Nickname:
Baptized: ♦ YES    ♦ NO   Baptism Date:
Confirmed: ♦ YES    ♦ NO   Confirmation Date:
Date of Birth:
  ♦ MALE     ♦ FEMALE
Is this person joining DLC?    ♦ YES    ♦ NO      
Father's First Name:
  Father's Last Name:
Mother's First Name:
  Mother's Last Name:
Current School:
 
Current Grade :
       
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