Personal Information:

			Male members, are you willing to participate?
	Last                                  First		Songs			Reading	Prayer
Name
Address1
Address2
City
State	ZIP
E-mail
Telephone
	If 17 or younger enter DOB   Be sure to print and complete the healthcare release on the next page.
	If 15 or younger name of responsible adult Be sure to print and complete the healthcare release on the next page.
Additional Family Members
					Male members, are you willing to participate?
	Last Name                         First Name	DOB			Songs	Reading	Prayer
Spouse
Child 1
Child 2
Child 3
Child 4
Child  5
Child 6
Child 7
Child 8

 

Housing questions may be directed to 

 

Jenny Jennings

(816) 268-0126 

joeandjennykay@gmail.com