Life Touch Ministries NFP DBA Life Touch Community Church-Plainfield

Child's First Name

Child's Last Name

Child's Date of Birth

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name

Marital Status

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Father: Have you received Christ as your personal Savior?

Yes

Other

Mother: Have you received Christ as your personal Savior?

Yes

Other

Are you a members of Life Touch Ministries?

Yes

In Progress

Message

Signature

Father's Signature - (First Name)

Last Name

Mother's Signature - (First Name)

Last Name