New Members Ministry

MEMBERSHIP APPLICATION

SECTION I: General Information

Date of Birth:

Age:

Home Address:

Address:

City:

State:

Zip:

Home Phone #:

Work Phone #:

Cell Phone#:

Email Address:

Permission to contact you via telephone?

Yes

Permission to contact you via email?

Yes

Date of Marriage:

Did your spouse join today?

Yes

Spouse’s D.O.B.:

Spouse’s Name:

Email Address:

Work Phone#:

Cell Phone#:

YOUR DECISION TODAY

Did you come forth to receive (please check which the box below):

SALVATION - Receive CHRIST for the 1st Time

Christian Experience / Membership to the Church

Rededication/Restoration of Your Life

Watch Care (I have membership somewhere else)

For Special Prayer

(Membership somewhere else) Where?

Special Prayer for:

If coming from another church, did you leave in “Good Standing”?

Yes

GETTING CONNECTED: You will be contacted to schedule your New Member Orientation Classes as your first step in becoming rooted here at Peek’s Chapel Baptist Church. These sessions are designed to help you grow in your faith, learn what we believe, and understand our church’s Vision and Mission.

At Peek’s Chapel, we are deeply committed to making disciples—equipping every member to be anchored in God’s Word and empowered to live out His purpose.

Do you have children?

Yes

**Children 18 and older must complete a separate Discipleship/ Membership Application Form**

SECTION II: Children’s Information (Ages 0-17)

Child #1

Name:

D.O.B.:

Age:

Gender:

Male

Female

Child’s Alternate Phone #:

Add 2nd Child?

Yes

Child #2

Name:

D.O.B.:

Age:

Gender:

Male

Female

Child’s Alternate Phone #:

Add 3rd Child?

Yes

Name:

D.O.B.:

Age:

Gender:

Male

Female

Child’s Alternate Phone #:

Add 4th Child?

Yes

Name:

D.O.B.:

Age:

Gender:

Male

Female

Child’s Alternate Phone #:

Add 5th Child?

Yes

Name:

D.O.B.:

Age:

Gender:

Male

Female

Child’s Alternate Phone #:

Please check this box if you give Peek’s Chapel Baptist Church permission to use your photo in promotional and/or advertising materials.