Membership Application

Name:

Last
First
Middle
Preferred Name: Date of Birth:
Marital Status:

PLEASE NOTE: If you are not married, please understand that we do not accept cohabitating (living together unwed). Members must be single or married.
Address:
City:
State:
ZIP:

Home Phone:

Cell Phone:
Work Phone: OK to call at work? Yes No
Email Address:

How did you hear about Covenant Love?  if other:

Military Branch:      Status:  Rank:
Occupation: Business Name:

Educational Background:
(List colleges attended, degrees earned, or special fields of study)

Received Jesus Christ as Lord and Savior? Yes No    Date:
Received the Baptism of the Holy Spirit? Yes No    Date:

Spouse :
Last
First
Middle
Wedding Anniversary:
Is spouse joining Covenant Love with you? Yes No
(If yes, please fill out information about your spouse below.)

If spouse is not joining Covenant Love, would he or she object to your being an active member and giver to Covenant Love? Yes No
Why or why not?

Spousal Information:
Preferred Name: Date of Birth:

Military Branch:      Status:  Rank:
Occupation: Business Name:

Work Phone:
OK to call at work? Yes No
Cell Phone:
Email Address:

Spouse received Jesus Christ as Lord and Savior? Yes No
Date:
Spouse received the Baptism of the Holy Spirit? Yes No
Date:

Educational Background:
(List colleges attended, degrees earned, or special fields of study)

Children Who Will Be Joining or Attending With You:
(If children are 18 or older and are joining, please, fill out a separate application for each.)
Number of children:
Name: Birthdate: Gender:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Other Family Members Living In The Home:
Name: Relationship:
1.
2.

Emergency Contact Information:
Name: Relationship:
Phone:
Address:
City: State: ZIP:

Previous Church Membership:
Church Name: Pastor:
Church Address:
Church Phone: How long were you there?
Reason for leaving:

Additional Information:
(Please give any other necessary information about yourself.)

Don't Forget! To complete the Membership Registration Process, be sure to sign up for an upcoming New Member's Class after you submit your application if you have not already done so!