Covenant Community Church New Members Orientation (Registration Form) Date * First Name * Last Name * Middle Name * Birthdate Street Address City State Zip * Phone Number * Email Address Have you received Jesus as your personal Savior? Yes No How long have you been a born again Christian (Saved)? Years Months Have you been baptized by immersion in water? Yes No Have you received the Baptism of the Holy Spirit with the evidence of speaking in other tongues? Yes No Were you a member of another church? Yes No Name of former church? If married, is your spouse also becoming a member of Covenant Community Church? Yes No Christian Lifestyle Are you currently dealing with any life dominating vice(s) and/or habit(s) that we could possibly assist you in overcoming? (Substance abuse, gambling, illicit sex, extra-marital sex, pornography, criminal activity, etc.) Yes No If yes, please explain: Affiliations Are you an active member of any organization, sorority or fraternity that has “spiritual” requirements for membership? (Example: You must believe in a supreme being to be a member). Yes No If yes, please note below: Childcare Section Childcare will be provided for children infants through twelve (12) years of age. Do you have a child or children who will need childcare while you attend orientation? Yes No
