Let's Connect!

We'd love to keep in touch with you! 
Please complete this form and submit.

Use this form if:

  • You are new to Berean and would like to be added to our database.
  • You are a member or regular attender and need to update your information we already have on file.

Or give us a call (419.756.3300) and we'd be glad to update your information.

For your information, we do not share your information with anyone else!  This is for our records only.

HEAD OF HOUSE INFORMATION:
Head of Household First Name:
Head of Household Last Name:
Head of Household Birthdate:
  MM DD YYYY
/ /
ADDRESS
Street, PO, Apt.:
City:
State:
Zip:
Land Line:
Head of Household Cell:
Are you:




Anniversary Date:
  MM DD YYYY
/ /
Head of Household Email Address:
SPOUSE INFORMATION
Spouse First Name:
Spouse Last Name:
Spouse Birthdate:
  MM DD YYYY
/ /
Spouse Cell:
Spouse Email Address:
FAMILY INFORMATION
Family Shared Email:
Child 1


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 2


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 3


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 4


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 5


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 6


Name:
First:
Last:
Grade Level:
Birthdate:
  MM DD YYYY
/ /
Child 7


Name:
First:
Last:
Grade Level
Birthdate:
  MM DD YYYY
/ /
Additional Children:
Enter the text you see in the security image: