Form Member Information Form New member information. Member Information FormContact Information - Primary PersonName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Enter Email Confirm Email Home Phone*Cell Phone*Gender Male Female Birthday Date Format: MM slash DD slash YYYY Would you like your birthday listed in our newsletter and receive a blessing on the Sunday closest to your day? Yes No Pledging: Would you like to receive a pledge number so that statements can be issued for your offering? Yes No If yes, do you want to receive a box of pledge envelopes, or, do you wish to use electronic payment? Envelopes Yes Electronic Payment (individuals set this up through their bank) Giving Portal on Website Primary Person Denomination & Sacramental Rite Information1a. I have been baptized. (If “no,” skip question 1b through 1d). Yes No 1b. Month, day, and year baptized Date Format: MM slash DD slash YYYY 1c. Denomination1d. Name of church, city & state where baptized1e. I have not been baptized in the Episcopalian Church but would like to be. Yes No 2a. I have been Confirmed. (If “no,” skip questions 2b & 2c) Yes No 2b. Denomination2c. Name of church, city & state where confirmed2d. I have not been confirmed in the Episcopalian Church, but would like to be? Yes No 3a. If you were baptized & confirmed by the Lutheran, Roman Catholic or Orthodox Church, would you like to be “received” (welcomed) into the Episcopalian Church? Yes No 4a. I am currently a member of another Episcopalian Church and want to transfer my membership to St. Philip’s. Yes No 4b. If “yes,” give current church name, street address, city & state.Contact Information - Spouse/PartnerName Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Enter Email Confirm Email Home PhoneCell PhoneGender Male Female Birthday Date Format: MM slash DD slash YYYY Would you like your birthday listed in our newsletter and receive a blessing on the Sunday closest to your day? Yes No Wedding Anniversary: Date Format: MM slash DD slash YYYY Would you like your wedding anniversary listed in our newsletter and receive a blessing on the Sunday closes to your day? Yes No Spouse/Partner Denomination & Sacramental Rite Information:1a. I have been baptized. (If “no,” skip questions 1b through 1d). Yes No 1b. Month, day, and year baptized. Date Format: MM slash DD slash YYYY 1c. Denomination1d. Name of church, city & state where baptized1e. I have not been baptized in the Episcopalian Church but would like to be. Yes No 2a. I have been Confirmed. (If “no,” skip questions 2b & 2c) Yes No 2b. Denomination2c. Name of church, city & state where confirmed2d. I have not been confirmed in the Episcopalian Church, but would like to be? Yes No 3a. If you were baptized & confirmed by the Lutheran, Roman Catholic or Orthodox Church, would you like to be “received” (welcomed) into the Episcopalian Church? Yes No 4a. I am currently a member of another Episcopalian Church and want to transfer my membership to St. Philip’s. Yes No 4b. If “yes,” give current church name, street address, city & state.Other Information: Primary Person Profession & HobbiesOther Information: Spouse/Partner Profession & HobbiesAgreement and Signature for Photographs, for the Epistle, Eblasts, and in Emergencies1. I give permission for my photo and that of my entire family to be used in church newsletters, brochures, or. the website. 2. I give permission to add all adult email addresses to your Epistle (monthly newsletter) distribution list. 3. I give permission to add all adult email addresses to your weekly Eblasts (announcements) distribution list. 4. I also give permission for any representative of St. Philip’s Episcopal Church to obtain medical care or transportation for myself and that of my entire family in the event of a medical emergency to include doctor’s care, medical transportation and emergency room admittance. Name* First Middle Last Suffix Consent* By checking this box, I agree to the above agreement for photographs, for the Epistle, Eblasts, and in Emergencies..Date* Date Format: MM slash DD slash YYYY Brief Description of Ministries/Committees/TeamsInterest @ St. Philip's - Primary Person Acolyte: Helps the priest before, during and after the worship service Adult Formation: Working with the rector offering seasonal spiritual material Altar Guild: Serving the rector, maintaining the sacristy, vestments and linens Bible Study: Adult group who studies various parts of the Bible Book Club: Adult fellowship discussing temporary books, enjoy fellowship and treats Buildings & Grounds: Committee overseeing and/or performing structural operations of our buildings for improvement and as required by the Village Catechesis: Sunday school studies from the old and new testaments, using the Montessori techniques Choir: Leads singing at 10:00 service (9:00 in the summer) Coffee Hour: Hosting the fellowship hour after the 10:00 service (9:00 in the summer) by bringing treats, and setting up/serving coffee Epistle Newsletter: Serve as a proofreader for our monthly newsletter Green Thumb: Maintains our grounds outside twice a month spring through fall Greeter: Welcomes everyone, and distributes worship bulletins and bulletin inserts In-reach: Assisting parishioners in need (i.e., transportation, cook or deliver meals) Lunch Bunch: Monthly gathering of women for fellowship and lunch Mission Outreach: Enriching the lives of those less fortunate in our community Newcomer: Helping guests become acquainted and integrated with St. Philip’s Nursery: Caring for infants & toddlers during the 10 am worship, and social events Publicity: Advertising our events in the community Social: Helping organize annual events: picnic, auction, Easter brunch, etc. Tai Chi: Open to the community, $5 per each half-hour weekly session Technology: Assist with our technical infrastructure Interest @ St. Philip's - Spouse/Partner Acolyte: Helps the priest before, during and after the worship service Adult Formation: Working with the rector offering seasonal spiritual material Altar Guild: Serving the rector, maintaining the sacristy, vestments and linens Bible Study: Adult group who studies various parts of the Bible Book Club: Adult fellowship discussing temporary books, enjoy fellowship and treats Buildings & Grounds: Committee overseeing and/or performing structural operations of our buildings for improvement and as required by the Village Catechesis: Sunday school studies from the old and new testaments, using the Montessori techniques Choir: Leads singing at 10:00 service (9:00 in the summer) Coffee Hour: Hosting the fellowship hour after the 10:00 service (9:00 in the summer) by bringing treats, and setting up/serving coffee Epistle Newsletter: Serve as a proofreader for our monthly newsletter Green Thumb: Maintains our grounds outside twice a month spring through fall Greeter: Welcomes everyone, and distributes worship bulletins and bulletin inserts In-reach: Assisting parishioners in need (i.e., transportation, cook or deliver meals) Lunch Bunch: Monthly gathering of women for fellowship and lunch Mission Outreach: Enriching the lives of those less fortunate in our community Newcomer: Helping guests become acquainted and integrated with St. Philip’s Nursery: Caring for infants & toddlers during the 10 am worship, and social events Publicity: Advertising our events in the community Social: Helping organize annual events: picnic, auction, Easter brunch, etc. Tai Chi: Open to the community, $5 per each half-hour weekly session Technology: Assist with our technical infrastructure I am interested in the sacrament of reconciliation/confession. Yes No I am interested in being anointed for healing. Yes No If yes, provide names:I would like to have coffee or lunch with the priest. Yes No If yes, provide name(s) and preferred day of the week (Tuesday, Wednesday, Sunday, Other).I would be interested in having a house blessing. Yes No I want to know more about the Episcopalian Church or the Chicago Diocese. Yes No The following members of my family have allergies. (Please list name(s) and allergy).The following members of my family have other health concerns that I would like to tell you about. (Please list name(s) and concern).I am in need of a handicap parking space/plan to use the elevator entrance. Yes No I occasionally need a ride to services or other events. (If yes, please sign up on the Ride-by-Your-Side sign-up sheet located in the Narthex.) Yes No Do you have any dependents?If yes, please continue filling in the form. If no, please click on the link below, which will take you to the end of the form, where you can click on the submit button.Click to go to SUBMIT button to send us your formDependent Child (#1) InformationName First Middle Last Suffix Gender Male Female Birthday Date Format: MM slash DD slash YYYY Would you like your birthday listed in our newsletter and receive a blessing on the Sunday closest to your day? Yes No Grade in SchoolNursery: Age 0-2 Are you interested in enrolling your child in the Nursery during the 10:00 Eucharist service? Yes No Catechesis: Age 3-12 Are you interested in enrolling your child in Catechesis (Sunday School) during the 10:00 Eucharist service? Yes No Acolyte: Are you interested in your child serving at as an Acolyte during the service? Yes, 8 am Yes, 10 am No Youth Group Yes No St. Philip’s currently doesn’t have a Youth Group for teenagers, but please keep me informed if this changes. Yes No Dependent Child (#1) Denomination and Sacramental Rite Information:1a. I have been Baptized. (If “no”, skip 1b, 1c and 1d). Yes No 1b. Date Date Format: MM slash DD slash YYYY 1c. Denomination1d. Name of church, city and state where baptized:1e. I have not been baptized in the Episcopalian Church but would like to be. Yes No 2a. I have been Confirmed. (If "no", skip questions, 2b and 2c). Yes No 2b. Denomination:2c. Name of church, city and state where confirmed:2d. I have not been confirmed in the Episcopalian Church but would like to be. Yes No 3a. If you were baptized and confirmed by the Lutheran, Roman Catholic or Orthodox Church, would you like to be “received” (welcomed) into the Episcopalian Church? Yes No Dependent Child (#2) InformationName First Middle Last Suffix Gender Male Female Birthday Date Format: MM slash DD slash YYYY Would you like your birthday listed in our newsletter and receive a blessing on the Sunday closest to your day? Yes No Grade in SchoolNursery: Age 0-2 Are you interested in enrolling your child in the Nursery during the 10:00 Eucharist service? Yes No Catechesis: Age 3-12 Are you interested in enrolling your child in Catechesis (Sunday School) during the 10:00 Eucharist service? Yes No Acolyte: Are you interested in your child serving at as an Acolyte during the service? Yes, 8 am Yes, 10 am No Youth Group Yes No St. Philip’s currently doesn’t have a Youth Group for teenagers, but please keep me informed if this changes. Yes No Dependent Child (#2) Denomination and Sacramental Rite Information:1a. I have been Baptized. (If “no”, skip 1b, 1c and 1d).. Yes No 1b. Date Date Format: MM slash DD slash YYYY 1c. Denomination1d. Name of church, city and state where baptized:1e. I have not been baptized in the Episcopalian Church but would like to be. (If "no", skip questions 2a through 3a). Yes No 2a. I have been Confirmed. (If “no”, skip questions 2b through 2c). Yes No 2b. Denomination:2c. Name of church, city and state where confirmed:2d. I have not been confirmed in the Episcopalian Church but would like to be. Yes No 3a. If you were baptized and confirmed by the Lutheran, Roman Catholic or Orthodox Church, would you like to be “received” (welcomed) into the Episcopalian Church? Yes No Dependent Child (#3) InformationName First Middle Last Suffix Gender Male Female Birthday Date Format: MM slash DD slash YYYY Would you like your birthday listed in our newsletter and receive a blessing on the Sunday closest to your day? Yes No Grade in SchoolNursery: Age 0-2 Are you interested in enrolling your child in the Nursery during the 10:00 Eucharist service? Yes No Catechesis: Age 3-12 Are you interested in enrolling your child in Catechesis (Sunday School) during the 10:00 Eucharist service? Yes No Acolyte: Are you interested in your child serving at as an Acolyte during the service? Yes, 8 am Yes, 10 am No Youth Group Yes No St. Philip’s currently doesn’t have a Youth Group for teenagers, but please keep me informed if this changes. Yes No Dependent Child (#3) Denomination and Sacramental Rite Information:1a. I have been Baptized. (If “no”, skip questions 1b, 1c and 1d). Yes No 1b. Date Date Format: MM slash DD slash YYYY 1c. Denomination1d. Name of church, city and state where baptized:1e. I have not been baptized in the Episcopalian Church but would like to be. (If "no", skip questions 2a through 3a). Yes No 2a. I have been Confirmed. (If “no”, skip questions 2b and 2c). Yes No 2b. Denomination:2c. Name of church, city and state where confirmed:2d. I have not been confirmed in the Episcopalian Church but would like to be. Yes No 3a. If you were baptized and confirmed by the Lutheran, Roman Catholic or Orthodox Church, would you like to be “received” (welcomed) into the Episcopalian Church? Yes No Comments: Δ
