HEAD OF HOUSEHOLD

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birth Date

MM

DD

YYYY

Wedding Anniversary

MM

DD

YYYY

Check each one that applies:

I give permission for my household's contact information to be included in the Grace Point Church Directory.

Please subscribe me to the weekly GraceVine email and GP family email group.

I understand that images of me and those in my household taken during Grace Point activities may be used in various online and printed publications including social media and the GP website.

SPOUSE

First Name

Last Name

Phone

(###)

###

####

Birth Date

MM

DD

YYYY

CHILD 1

First Name

Last Name

Birth Date

MM

DD

YYYY

CHILD 2

First Name

Last Name

Birth Date

MM

DD

YYYY

CHILD 3

First Name

Last Name

Birth Date

MM

DD

YYYY

CHILD 4

First Name

Last Name

Birth Date

MM

DD

YYYY

CHILD 5

First Name

Last Name

Birth Date

MM

DD

YYYY

CHILD 6

First Name

Last Name

Birth Date

MM

DD

YYYY