Event Registration

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New Members Class - Fall 2021 on Sunday, September 12, 2021 @ 9:30 AM

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*Date of Birth (mm/dd/yyyy):
*Gender:
*How long have you been attending Fourth:
*Are you currently a member of another church:
Please indicate the name of church/address:
List other family members living within your household
*Have you been baptized:
If yes, please list church name and date of baptism
If you have children who have been baptized elsewhere, please indicate the date(s) of baptism and the name the church
Please submit your photo to rkorossy@4thpres.org so that those teaching the class can get to know you better.
I give permission for photos/videos of myself taken during class to be used for future Fourth publications and on the website. NO identifying information shall be included. Photos in the online Membership Directory are connected to your record for members view only. You will have the option of omitting them from view.:
*I give permission :
Additional Information for Youth
Parents' Names:
Parents' Cell Numbers:
Parent emails:
School:
Grade as of Sep 2021:
Please list any additional information we should know.: