information

If Elim is your home church, or you are wanting it to be your home, then we would appreciate you taking the time to fill in this form as accurately as possible for all members of your family attending Rotorua Elim. This information is only for internal church use and used to help us serve you better.

Your Name *

First

Last

Your Gender *

Your Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Your Age Group *

Home Phone *

Your Mobile Number *

If you use your partners mobile please enter this in the field later and leave this field blank.

Please fill in the following if you have a partner or spouse (optional).

My partner attends Rotorua Elim *

Yes No

Please fill out the following for each child under your care that will be coming to Rotorua Elim Church

1. Child Name *

2. Child Name *

3. Child Name *

4. Child Name *

5. Childs Name *

6. Child Name *

1. DOB *

2. DOB *

3. DOB *

4. DOB *

5. DOB *

6. DOB *

General Comments *

Thanks for helping us better serve you!