New Member Class – Getting to Know You Which class will you attend?* Fall 2026 Spring 2027 Status* Married Widowed Divorced Single College Date Married:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Title* Mr. Mrs. Miss Ms. Dr. Name – please enter n/a to field that doesn't pertain to you* First Middle Last Suffix or Maiden Name If you have a preferred name you go by that is different from your first name, please enter it here: Preferred name Birthdate:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender:* Male Female Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone (Leave blank if you do not have a home phone.)Cell Phone (Leave blank if you do not have a cell phone.)Email* Have you been baptized before?* Yes No What is the name of the church?*What is the year you were baptized?*Vocation:Have you been a communing member of Christ Covenant Church before?* Yes No In the PCA, are you an ordained Teaching Elder? Yes No Spouse's Title* Mr. Mrs. Miss Ms. Dr. Spouse's Name – please enter n/a to field that doesn't pertain* First Middle Last Suffix or Maiden Name If you have a preferred name you go by that is different from your first name, please enter it here: Preferred name Birthdate:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender:* Male Female Is your spouse attending the membership class?* Yes No Home Phone (Leave blank if you do not have a home phone.)Cell Phone (Leave blank if you do not have a cell phone.)Email* Has your spouse been baptized?* Yes No What is the name of the church?*What is the year your spouse was baptized?*Vocation:Have you been a communing member of Christ Covenant Church before?* Yes No #1 Do you have children living at home or in college?* Yes No Children's Information – Please list all dependents under the age of 18. Also, list dependents under the age of 23 if enrolled in post high school education. Child #1 First Name Middle Name Last Name Last School Grade Completed Birthday of Child #1 MM slash DD slash YYYY Is Child #1 Attending the New Member Class? Yes No Has Child #1 Been Baptized? Yes No What is the name of the church?What is the year they were baptized?Child #2 (if applicable) First Name Middle Name Last Name Last School Grade Completed Birthday of Child #2 (if applicable) MM slash DD slash YYYY Is Child #2 Attending the New Member Class? Yes No Has Child #2 Been Baptized?* Yes No What is the name of the church?What is the year they were baptized?Child #3 (if applicable) First Name Middle Name Last Name Last School Grade Completed Birthday of Child #3 (if applicable) MM slash DD slash YYYY Is Child #3 Attending the New Member Class? Yes No Has Child #3 Been Baptized? Yes No What is the name of the church?What is the year they were baptized?Child #4 (if applicable) First Name Middle Name Last Name Last School Grade Completed Birthday of Child #4 (if applicable) MM slash DD slash YYYY Is Child #4 Attending the New Member Class? Yes No Has Child #4 Been Baptized? Yes No What is the name of the church?What is the year they were baptized?Child #5 (if applicable) First Name Middle Name Last Name Last School Grade Completed Birthday of Child #5 (if applicable) MM slash DD slash YYYY Is Child #5 Attending the New Member Class? Yes No Has Child #5 Been Baptized? Yes No What is the name of the church?What is the year they were baptized?
