Trinity Peoria - Child Membership Record

Child Membership Information sheet

First Name, Middle Name

Last Name

Home Phone Number

Cell Phone Number

Address:

Please list school your child attends and grade level:

List Birthdate and Birthplace:

Father's Name:

Mother's Name:

Parent Phone Number (if different that above)

Has your child been Baptized?
Yes
No

Congregation where Baptized (include denomination and Synod) City, State:

Pastor's Name:

Sponsor's Names:

Has your child been Confirmed?
Yes
No

Congregation where Confirmed (include denomination and Synod) City, State:

Pastor's Name: