Worship & Sunday School: Sundays at 9:30am

Directory Formadmin2024-02-27T20:56:36+00:00

Directory Form

Please fill out all of the information and click “Submit” at the bottom of the page. You can also download the PDF version here.

Household Family/Directory Data

Household Name *

Address *

City *

State *

Zip *

Secondary Address

Reason

City

State

Zip

Main Phone *

Cell or Home

Cell

Home

Email *

Are you currently affiliated with another congregation?

Yes

Name and Address of Congregation

Adult Family Member #1

Last, First Name *

Middle Name

Phone *

Email *

Gender *

Male

Female

Birthdate *

Place *

Baptism Date *

Place *

Confirmation Date *

Place *

Marriage Date *

Place *

Married To (Include Maiden Name)

Employer *

Employer Phone Number *

Adult Family Member #2

Last, First Name

Middle Name

Phone

Gender

Male

Female

Birthdate

Place

Baptism Date

Place

Confirmation Date

Place

Marriage Date *

Place *

Married To (Include Maiden Name)

Employer

Employer Phone Number

Child Family Member #1

Last, First Name

Middle Name

Phone

Gender

Male

Female

If a student, what school?

Grade

If a college student, their address

Birthdate

Place

Baptism Date

Place

Confirmation Date

Place

Child Family Member #2

Last, First Name

Middle Name

Phone

Gender

Male

Female

If a student, what school?

Grade

If a college student, their address

Birthdate

Place

Baptism Date *

Place

Confirmation Date

Place

Child Family Member #3

Last, First Name

Middle Name

Phone

Gender

Male

Female

If a student, what school?

Grade

If a college student, their address

Birthdate

Place

Baptism Date *

Place

Confirmation Date

Place

Child Family Member #4

Last, First Name

Middle Name

Phone

Gender

Male

Female

If a student, what school?

Grade

If a college student, their address

Birthdate

Place

Baptism Date *

Place

Confirmation Date

Place

Thank you for submitting your directory information.

There was an error trying to send your message. Please check all required fields and try again.

Worship & Sunday School: Sundays at 9:30am

9886 Vermont Church Road | Black Earth, WI 53515
608-767-3312 | vermont_church@tds.net