CYPHC Membership Data Form

Help us stay connected! Please fill out or update your details in this form to ensure we have your most current information for the Celebrity Youth ministry.

First Name

Last Name

Date of Birth:

Gender

Male

Female

Phone/Mobile

Residential Address:

Residence Address

City

State

Country

Are you a member of Potters House Church, Port Harcourt City?

Which church do you attend?

When did you join Celebrity Youth?

Are you involved in any other ministry/department in the church?

Dropdown

Please specify:

Areas of Spiritual Interest:

Please specify

What are your talents/skills?

What are your hobbies/interests outside of church?

Emergency Contact Full Name:

Emergency Contact Relationship:

Emergency Contact Phone Number:

Highest Educational Qualification:

Occupation/Field of Study:

Any specific needs or prayer requests you'd like to share confidentially?

Data Privacy Consent:

I consent to Celebrity Youth PHC collecting and storing this information for ministry purposes, in accordance with their privacy policy.

CYPHC Membership Data Form

CYPHC Membership Data Form

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