Head of Household Name #1:

Email Address:

Primary Phone #:

Text? Text? Yes No

Secondary Phone # (for church office only, not published):

Text? Text? Yes No

Head of Household Name #2:

Email Address:

Primary Phone #:

Text? Text? Yes No

Secondary Phone # (for church office only, not published) :

Text? Text? Yes No

Home Address:

Winter Address (if applicable; for church office only, not published):

What months are you at the above winter address?

Additional Household Member(s): (Name, Birthday, Email Address, Cell #)

Permission to be included in Online Church Directory Permission to be included in Online Church Directory Yes, include me/us in password-protected online directory available only to BBC families (members & regular attenders) No, do not include me/us in the password-protected online church directory.

Specify information that is for Church Office use only and to be excluded from the paper directory and/or online directory