Liberty Member Record Update Form

Please complete this form if you are a new member to our church family or if you have a change of details.

*Please note that ALL information provided will be held private and confidential.

First Name

Middle Name

Last Name

Date of Birth

Gender

Marital Status

Anniversary

Home Address

Home City

Home State

Home Postcode

Email Address

Mobile Number

Does your spouse come to church with you?

Spouse First Name

Spouse Middle Name

Spouse Last Name

Spouse Date of Birth

Spouse Email Address

Spouse Mobile Number

Do you have children who come to church with you?

Child Name (1)

Child Date of Birth (1)

Child School Grade (1)

Child Name (2)

Child Date of Birth (2)

Child School Grade (2)

Child Name (3)

Child Date of Birth (3)

Child School Grade (3)

Child Name (4)

Child Date of Birth (4)

Child School Grade (4)

Child Name (5)

Child Date of Birth (5)

Child School Grade (5)

Child Name (6)

Child Date of Birth (6)

Child School Grade (6)

Thank you for filling out this form and if you are a new member we are so excited that you have chosen Liberty as your church family.