First Lutheran Church | Janesville, WI

612 N Randall Ave, Janesville, WI 53545

608-752-7434 | office@flcj.org

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New Member

If you wish to become a member of First Lutheran Church please fill out the New Member Form below. Once this form is completed you will be contacted by the church.

If you have questions, contact the church office at office@flcj.org or 608.752.7434.

Name (First, Middle, (Maiden), Last) *

Sex *MaleFemaleOther

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Date of Birth *

Place of Birth *

Ethnic background (ELCA data request)

Baptized? *YesNo

Date & Congregation

Confirmed? *YesNo

Date & Congregation

High School Graduation Date

Marital Status

Date Married

Place of Employment

Occupation

Work Phone

Retired?YesNo

Is PARTNER joining?YesNo

Partner’s Name (First, Middle, (Maiden), Last)

Partner’s SexMaleFemaleOther

Partner’s Email Address

Partner’s Phone

Partner’s Date of Birth

Partner’s Place of Birth

Partner’s Ethnic background (ELCA data request)

Is Partner Baptized? *YesNo

Partner’s Date & Congregation

Is Partner Confirmed? *YesNo

Partner’s Date & Congregation

Partner's High School Graduation Date

Partner’s Place of Employment

Partner’s Occupation

Partner’s Work Phone

Is Partner Retired?YesNo

Child 1 Name

Child 1 SexMaleFemaleOther

Child 1 Age

Child 1 Date or Birth

Is Child 1 Baptized?YesNo

Child 1 Date of Baptism

Is Child 1 Confirmed?YesNo

Child 1 Date of Confirmation

Child 2 Name

Child 2 SexMaleFemaleOther

Child 2 Age

Child 2 Date or Birth

Is Child 2 Baptized?YesNo

Child 2 Date of Baptism

Is Child 2 Confirmed?YesNo

Child 2 Date of Confirmation

Child 3 Name

Child 3 SexMaleFemaleOther

Child 3 Age

Child 3 Date or Birth

Is Child 3 Baptized?YesNo

Child 3 Date of Baptism

Is Child 3 Confirmed?YesNo

Child 3 Date of Confirmation

Child 4 Name

Child 4 SexMaleFemaleOther

Child 4 Age

Child 4 Date or Birth

Is Child 4 Baptized?YesNo

Child 4 Date of Baptism

Is Child 4 Confirmed?YesNo

Child 4 Date of Confirmation

Please give names and ages of any children who will not be joining

Are you currently members of another church? *YesNo

Name of Church

Is present Church ELCA?YesNo

Church Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Partner 1 Father's Name *

Partner 1 Mother's Name (include maiden) *

Partner 2 Father's Name *

Partner 2 Mother's Name (include maiden) *

Do You Have an Alternate Address? *YesNo

If YES Alternate Address

Month to start mail to alternate address

Month to stop mail to alternate address

Would you like to receive our printed newsletter “The Progress” by mail? *YesNo

Would you like offering envelopes or information on electronic giving? *Offering EnvelopesInformation on Electronic Giving

Please give a personal paragraph about you: (skills, interest, family and activities)

What school does your child attend? What grade? Sports/Music? Other Interests? Etc.

CONTACT

First Lutheran Church
612 N Randall Ave
Janesville, WI 53545
608.752.7434
office@flcj.org

WORSHIP

Sunday Mornings
8am (In-Person)
9:30am (In-Person & Livestream)

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