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Donation Total: $100.00
Please complete one form for each new child member.
Child First Name *
Child Middle Name
Child Last Name*
Gender* MaleFemale
Birth date*
Parent/Guardian Full Name*
Home Address*
City*
State*
Zip Code*
Parent/Guardian Cell Phone*
Parent/Guardian Home Phone
Parent/Guardian Work Phone
Parent/Guardian Email*
How Did You Join BaptismChristian ExperienceRe-DedicationReinstatementReferralOther
This information will only be used for the purposes of keeping you informed and updated on the life of our church.
