The forms are linked here. - Herndon United Methodist Church

Household Information Form
Herndon UMC Membership Survey/Registration for 2014-15
Are you in? Herndon UMC is looking to update membership information and issue a new member directory. All
those participating in Herndon UMC worship, programs, and ministries in 2014-15 are asked to complete a
Household Information sheet for each household and an Individual Information Sheet for each person in the
household. There are separate individual information forms for adults and children/youth.
To make it a complete package, add a photo of your household. You may submit a family picture with these forms
or to [email protected]. Photographers will also be available at Herndon UMC around worship times in
September for individual, group and family pictures. No appointment or purchase necessary, just come as you are.
“Publish in directory?” below applies only to a printed church directory. Herndon UMC is also considering
implementing a password-protected, on-line directory.
If created, would you use an on-line directory? □ Yes or □ No
FAMILY INFORMATION
Household Name:
Number of individuals in household:
□ Publish in directory?
Residence Street Address:
City:
State:
□ Publish in directory?
Zip:
□ Publish in directory? Office Use:
Mailing Address (if different):
City:
Home Phone:
State:
Zip:
□ Publish in directory?
□ Receive Friday emails?
□ Receive Newsletter?
□ Include in Prayer Chain?
PLEASE PROVIDE US WITH INFORMATION ABOUT THE FOLLOWING PROGRAMS/MINISTRIES:
(Please check all that you would like to know more about.)
Family Email:
Service
□ Ezra Ministry (local rebuilding)
□ HHS Partnership/Tutoring
□ LINK, Inc.(local food bank)
□ Living Waters for the World
□ United Methodist Men
□ United Methodist Women
□ Volunteers In Mission (VIM)
(national and international)
□ Youth Led Missions
□ Acolytes/Cross Bearers
□ Communion Assistants
□ Liturgists
□ Ushers/Greeters
Enrichment
□ Adult Studies/Sunday School
□ College Ministries
□ Youth Sunday School
□ Youth Group
□ Confirmation
□ Kid’s Worship
□ Children’s Sunday School
□ HUMC Preschool
Music/Performance
□ Adult & Youth Choirs & Bells
□ Children’s Choirs & Bells
□ Connection Band
□ Instrumental Music
□ Puppet Ministries
Special Interests
□ Nursery
□ UPWARD Basketball
□ Vacation Bible School
□ Top of the Hill (Seniors)
□ Young Adults
□ History Ministry
□ Women at the Well (Book Club)
□ Yarn & Thread (Knitting, etc.)
□ Scout Troop 157
□ Other:
□ Sunday Fellowship Helpers
□ Reception & Funeral Helpers
□ Church Council/Committees
If an on-line directory is created, is there information that you have marked “Publish in directory?” that you
would not want available online? If so, what?
CHILD/YOUTH Individual Information Form
Herndon UMC Membership Survey/Registration for 2014-15
PLEASE COMPLETE ONE INDIVIDUAL FORM PER FAMILY MEMBER
Office Use:
Household Name:
First Name/Initial:
Middle Name/Initial:
Nickname:
Last Name:
Suffix (eg. Jr.):
Gender:
□ Male
Date of Birth:
If a student, Grade
for 2014/15:
Individual Phone (cell):
□ Female
□ Publish in directory?
□ Receive Friday emails?
□ Receive Newsletter?
□ Include in Prayer Chain?
Individual Email (best):
Skills and Interests:
Please list any allergies, health conditions, medications, food intolerance, or other needs for this individual.
Emergency Contact (other than parent):
Phone (best):
Permission for Participation and for Emergency Treatment, if necessary.
The child/youth listed on this form has my permission to attend Herndon United Methodist Church's (HUMC) programs and
events.
I hereby authorize HUMC or the designated chaperone to seek medical treatment for my child, at the nearest facility, in the
event medical care is required. I understand that neither HUMC nor the adults in charge can be held responsible for any
accidents or injuries that might occur.
Parent/Guardian Signature:
Date:
If you DO NOT want your child in video clips and photographs published on HUMC's website or in HUMC
brochures, please initial here. ________
THIS INDIVIDUAL INTENDS TO PARTICIPATE IN THE FOLLOWING PROGRAM(S):
(Please check all that apply.)
For Children (to Grade 6)
□ Nursery
□ Kids’ Worship
□ Children’s Sunday School
□ Joyful Noise (Choir, 3yr-Grade 2)
□ One Accord (Choir, Grade 3-6)
□ Gloria Bells (Grade 3-6)
□ Hands Up for God (Puppets, Grade 3-6)
□ Christmas Pageant
□ Acolytes/Cross Bearers
For Students (Grade 7-12)
□ Jr. High Sunday School
□ Sr. High Sunday School
□ Youth Group
□ Confirmation in 2014-15
□ Youth Choir
□ New Generation Ringers (hand bells w/ adults)
□ Out of the Darkness (Puppets)
□ Acolytes/Cross Bearers
□ Other Committee(s), please list:
ADULT Individual Information Form
Herndon UMC Membership Survey/Registration for 2014-15
PLEASE COMPLETE ONE INDIVIDUAL FORM PER FAMILY MEMBER
Office Use:
Household Name:
First Name/Initial:
Middle Name/Initial:
Last Name:
Nickname:
Gender:
□ Male
□ Female
Suffix (eg. Jr.):
Date of Birth:
Individual Phone (cell):
□ Publish in directory?
□ Publish in directory?
□ Receive Friday emails?
□ Receive Newsletter?
□ Include in Prayer Chain?
May use the year 1900 in place of actual year.
Individual Email (best):
Occupation:
Work Phone:
□ Publish in directory?
Skills and Interests :
If you DO NOT want to be included in video clips and photographs published on HUMC's website or in
HUMC brochures, please initial here. ________
THIS INDIVIDUAL INTENDS TO PARTICIPATE IN THE FOLLOWING PROGRAM(S):
(Please check all that apply.)
Sunday School/Studies:
Sundays at 10:10am or as noted.
□ Adventures in Bible Study (Su am)
□ Couples Class (Su am)
□ Good News Adult Study (Su am)
□ Just Come Adult Study (Su am)
□ Real Life Adult Study (Su am)
□ Sun. Evening Study (Su 6pm)
□ Mon. Morning Men (Mo 7:30am)
□ Young Adult Mon. Nights (Mo 7pm)
□ Tues. Men’s Bible Study (Tu 7pm)
□ Tues. Morning Study (Tu 9:30am)
□ Tues. Women’s Bible Study (Tu 7pm)
Musical & Performing Groups:
□ Wesley Choir (Su 9am)
□ Chancel Ringers (Advanced)
□ New Generation Ringers
(w/ youth)
□ Other Instrumental:
Worship:
Below, circle applicable services:
□ Communion Assistants
(Sa 5:30pm, Su 9am, Su 11am)
□ United Methodist Men
□ United Methodist Women
Circle:_____________________
□ Ushers/Greeters
(Sa 5:30pm, Su 9am, Su 11am)
□ Liturgists
(Sa 5:30pm, Su 9am, Su 11am)
□ College Ministries
Fellowship Team
□ Connection Café (Su 10 am)
□ Receptions, Funerals, & Events
□ Team Support (shopping, etc.)
□ Other Herndon UMC
Committee(s), please list:

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