Calvary Baptist Church | Leavenworth, KS

Your Contact Information

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Last Name

Birthdate

Phone Number

Email

Spouse Contact Information

First Name

Last Name

Birthdate

Phone Number

Email

Wedding Anniversary

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Do you have children or grandchildren attending with you?

Yes

No

Children

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Birthdate

Gender

Grade

Allergies

Other Family Information

Does anyone in your family have a medical condition you feel our church should be aware of in order to minister to your family better?

Yes

No

Please explain:

Are you associated with the military or here temporarily?

Yes

No

If possible, please let us know when you expect to move:

May the contact information (only) be included in the church directory? If not, it will be available only to the church leaders.

Yes

No

Family Photo

Please email a family photograph, or pictures of each family member, to deacons@calvaryleavenworth.com.

Email Sent

Yes

No

family information

Your Contact Information

Spouse Contact Information

Children

Other Family Information

Family Photo

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