Kernersville   Greensboro   Home

If you have already filled out this form on line please do not submit another copy, log on and make changes to the original form.
   Log On

Required fields are marked with an *.
* I agree with the Statement of Faith without reservation. Yes   No
* I have been immersion baptized. Yes   No
* I accepted Jesus Christ as my savior in  (Year)   What does this mean?
* First Name
* Last Name
Address
City
State Zip
Primarily Attend
Home Phone
Cell Phone
Best time to call
* Email
* Birthdate mm/dd/yyyy
(If you're under 18 a parental signature will be required)
Male  Female
Do you have any health limitations?
Yes  No
Marital Status
Spouse's Name (if married)
Number of Children
Trade or Profession
Picture

To aid our church staff in getting to know you, we ask that you upload a portait type picture of yourself. A picture is required to complete your sign up process. If you are unable to post a picture, please visit the church office and we will take a picture for you.

Please send all pictures in .jpg format.

* I began attending Calvary Chapel regularly...
(Give an approximate date even if you don't know exactly)
  format mm/dd/yyyy
2008 (c) Calvary Chapel of the Triad. All rights reserved.
365 W. Bodenhamer Street • Kernersville, NC 27284 • 336.996.6880