HBC Directory

Provide Contact & Directory Information

If you're part of us here at HBC we'd love to keep in touch! Just fill out the form below and you'll be connected. Don't forget to fill out information below for everyone at your home (including children under 15). For those 15 years and older, please have them fill out a separate form as we record them separately. Please only fill out information for yourself and your direct family.

Thanks and God bless!

First Adult:

* Indicates required field

Name *

First

Last

Also known as (Nickname etc.) *

Email *

Gender *

Date of birth *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Mobile Phone Number *

Home Phone Number *

PLEASE NOTE:
The contact info provided for "First Adult" will, by default, become the contact info for this person/couple/family. If you would like a second adult to be contactable seperately, please make sure you fill in the fields for "Second Adult" below.

Second Adult (if applicable):

Name *

First

Last

Also known as (Nickname etc.) *

Email *

Gender *

Date of birth *

Mobile Number *

Children under 15 (please use separate form for 15 years+):

First Child *

First

Last

Gender *

Date of birth *

Second Child *

First

Last

Gender *

Date of birth *

Third Child *

First

Last

Gender *

Date of birth *

Fourth Child *

First

Last

Gender *

Date of birth *

Fifth Child *

First

Last

Gender *

Date of birth *

NB: If you have more children to add, please fill in a second form (including the first adult compulsory details re-entered). Thanks.

Other information:

Other information I'd like: *

Other things I would like to offer to help with: *

Access and permission:

Would you like us to email you instructions about how to access the Directory on your smart phone? *

Yes No Tell me more

Name of the person filling out this form? *

I give permission for the name(s), contact details, and any photo(s) provided on this form, plus details supplied directly to the Church office by me, to be published in the Henderson Baptist Church Fellowship Directory and made available to other HBC Directory users. *

Yes No

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