Contact Preferences Form

* Name:
Address:
Home Phone Number:
Mobile Phone Number:
* Email address:
Birthday in DD/MM format e.g. 01/06 = 1st June:
Consent. I give my consent for my: to be included in the Church Directory:	Name Address Home Phone Number Mobile Phone Number Email Address Birthday
Lists and Prayer Diary. Please indicate by ticking which list(s) you would like to be included in::	All Email List - this is the email that goes to All members e.g. Notices Prayer Email List Prayer Diary Birthday List One Chapter a Day Email One Chapter a Day WhatsApp Group
* Adult section completed:	Please tick the box to show that you have completed the sections above. Now, either continue and fill the details for your child/children or go to the end of the form to the Signature section.
Parental Consent:	As a parent/guardian of my child/children, I consent to their data being held.
Child's Name:
Child's birhday (in the DD/MM format):
Child's name:
Child's birhday (in the DD/MM format):
Child's name:
Child's birhday (in the DD/MM format):
Child's name:
Child's birhday (in the DD/MM format):
Child's name:
Child's birhday (in the DD/MM format):
Child's name:
Child's birhday (in the DD/MM format):
* 'Signature':	I understand that my consent is required for my information to be included in the Church Directory.
Please enter the verification number:*
* Required Fields