Community Baptist Church of Greater Milwaukee
Youth Member Profile Update
*Youth (under 18) If you are in College, please use this form & your college mailing address, if applies. Thank You!
page 1 of 1
Name *
required
First Name
Last Name
Address *
Address
Address Line 2
---------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Marshall Islands
Micronesia
Northern Marianas
Palau
Puerto Rico
Trust Territories
Virgin Islands
Armed Forces(AA)
Armed Forces(AE)
Armed Forces(AP)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territory
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
City
State
Zip Code
Gender *
select one
Select from list
select one
Male
Female
Date of Birth
required
Click in box to select date
Your Age
required
Home Phone Number
required
Phone Number
Cell Number
required
Phone Number
Do you wish to receive text messages?
select one
Select from list
Yes
No
E-mail address
required
Email Address
Attending School
required
Current Grade Level
required
In case of emergency, contact: *
required
Relationship: *
required
Phone Number *
required
Phone Number
What are your special gifts or talents:
required
Do you have brothers/sisters that do/do not attend Community Baptist Church? If so, please list names & ages:
required
* required