Contact Information Update Form
PLEASE NOTE THE FOLLOWING INFORMATION BEFORE COMPLETING THIS FORM: Completion of this form does not constitute an application for or grant membership to PCN. Submission of this form does not grant the submitter any legal claim to a relationship with PCN. This form is provided solely for the purpose of providing updated information for internal PCN records, and the information provided on this form will be used for that purpose only. Information provided on this form will be kept in the strictest confidence. By submitting your information, you agree that PCN may use the information you have provided to update its internal records and to communicate messages of relevance to the PCN membership as a part of the normal communications between the church and its congregation. Further, you agree not to hold PCN, its agents, or others affiliated with the organization liable for errors in the information, or for mistakes which may result from the use of faulty information provided on this form.
--- The following fields are for the Head of Household. ---
Title (*)
Please select from the available choices
Name (*)
Please enter a name as FIRST MIDDLE LAST
Please provide the first, middle or maiden, and last name.
Gender (*)
Please select the gender of the head of the household
Birthday
Please select the head of household's birthday
(Optional) Provide as mm/dd/yyyy
Preferred or Nickname
Invalid Input
(Optional) Enter a preferred name or nickname if different from the legal name.
Address: (*)
Please enter the head of household's legal address
Alternate Address
Invalid Input
(Optional) Provide an alternate address if applicable. This may be a winter or summer mailing address that is NOT the primary residence.
Home Phone
Invalid Input
Cell Phone
Invalid Input
(Optional)
Work Phone
Invalid Input
(Optional)
Additional Phone
Invalid Input
(Optional)
Keep Private



Invalid Input
Check the phone number(s) provided above that you would like PCN to keep private in their records.
E-Mail Address
Please enter a valid e-mail address
(Optional) This should be a primary e-mail address
Marital Status (*)
Invalid Input
Occupation
Invalid Input
(Optional)
Employer
Invalid Input
(Optional)
Membership Status (*)
Invalid Input
Please select a membership status.
Religious Background
Invalid Input
(Optional) Please describe the religious background of the head of the household.
Classes
Invalid Input
(Optional) Please list any christian education classes the head of the household participates in at PCN.
Baptized?
Invalid Input
Date of Baptism
Invalid Input
--- For the following groups, please select as many items as apply to the head of the household. ---
Skills














Invalid Input
Other Skills
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other skills.
Activities





Invalid Input
Other Activites
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other activities.
Spiritual Gifts







Invalid Input
Other Gifts
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other gifts.
Willing to serve









Invalid Input
Other Service
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other areas of service.
   
--- The following fields are for the SPOUSE. ---
Title
Please select from the available choices
Name
Please enter the name of the spouse
Please provide the first, middle or maiden, and last name.
Gender
Please select the gender of the spouse
Birthday
Please select the spouse's birthday
(Optional) Provide as mm/dd/yyyy
Preferred or Nickname
Invalid Input
(Optional) Enter a preferred name or nickname if different from the legal name.
Address:
Please enter the head of household's legal address
Alternate Address
Invalid Input
(Optional) Provide an alternate address if applicable. This may be a winter or summer mailing address that is NOT the primary residence.
Home Phone
Invalid Input
Cell Phone
Invalid Input
(Optional)
Work Phone
Invalid Input
(Optional)
Additional Phone
Invalid Input
(Optional)
Keep Private



Invalid Input
Check the phone number(s) provided above that you would like PCN to keep private in their records.
E-Mail Address
Please enter a valid e-mail address
(Optional) This should be a primary e-mail address
Anniversary
Invalid Input
Occupation
Invalid Input
(Optional)
Employer
Invalid Input
(Optional)
Membership Status (*)
Invalid Input
Please select a membership status.
Religious Background
Invalid Input
(Optional) Please describe the religious background of the spouse.
Classes
Invalid Input
(Optional) Please list any christian education classes the spouse participates in at PCN.
Baptized?
Invalid Input
Date of Baptism
Invalid Input
--- For the following groups, please select as many items as apply to the spouse. ---
Skills














Invalid Input
Other Skills
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other skills.
Activities





Invalid Input
Other Activites
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other skills.
Spiritual Gifts







Invalid Input
Other Gifts
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other skills.
Willing to serve









Invalid Input
Other Service
Invalid Input
(Optional) If you selected 'Other', please provide a list of the other skills.
   
Children
Invalid Input
Please enter the name(s) of any children living in the household under the age of 18.
Birth Date(s)
Invalid Input
For each child, please provide their birthday at month/day/year. (One per line)
Grades
Invalid Input
Please provide the school grade for each child listed above.
Date of Baptism
Invalid Input
For each child listed above, please provide a baptism date if applicable.
Classes
Invalid Input
For each child listed above, please provide their current class at PCN if applicable.
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