CLASS SIGN UP

Class

* Required Fields

Last Name* First Name*  

Preferred Goesby Name*    Middle Name*

Maiden Name  Spouse Name (only if spouse is not joiing)  

Street Address*

City*  State*  

Zip*  Subdivision*

Preferred Phone Number *  

  Please Specify* Cell Home Work  

Email*

Date of Birth*   Date of Marriage*  Place of Birth*  

Marital Status* M S D W  Baptized Yes  No  Male  Female 

Occupation*

Employer/School*

Retired  As

Special Gifts/Interests* 

 

Children:

 

Child #1: First Name   Middle Name    Last Name   Goesby  Date of Birth*      Place of Birth (City, St)*     Baptized?* Yes No  Male Female 

Confirmed?* Yes  No  Name of School

 

Child #2: First Name*    Middle Name*     Last Name*   Goesby  Date of Birth*       Place of Birth (City, St)*     Baptized?*  Yes  No Male  Female  

Confirmed?* Yes  No  Name of School

 

Child #3: First Name*   Middle Name*   Last Name*    Goesby  Date of Birth*     Place of Birth (City, St)*    Baptized?*  Yes  No  Male Female

Confirmed?* Yes  No Name of School

 

Child #4: First Name*   Middle Name*    Last Name*   Goesby  Date of Birth*     Place of Birth (City, St)*    Baptized?*  Yes  No  Male Female

Confirmed?* Yes  No Name of School

 

How Will You Join* Baptism Reaffirmation of Faith Transfer  Name & Address for Church of Transfer*

Relative of MPPC:*  Name   Relation