Mission House Registration Form

Please present a photo ID to our Greeter upon arrival.

The information on this form is for Charity Tracker purposes only & will not be shared with anyone outside of our Mission House Ministry.

Charity Tracker Assistance Network is a shared, computerized record-keeping system that captures information about people experiencing a need for emergency services. The Cumberland Baptist Association administers Charity Tracker on behalf of participating agencies including Spring Creek Baptist Church.

If you refuse or are unable to give this information you will not be able to participate in our full program but we will still help out where we can.

Name

Phone

Address

Date of Birth (mm/dd/yyyy)

This address will receive a confirmation email

ID#

Date of Planned Visit to the Mission House

Please provide the names, birthdays, and relationship to the primary applicant of all additional residents at the address listed above.

I understand that the information gathered about me is personal & private and I do not have to participate in Charity Tracker. I have had an opportunity to ask questions about Charity Tracker which is authorized by this release to share with other Charity Tracker participating agencies (please call 9316475850 with questions). This release of Information will remain in effect for 3 years from the date of completing this form unless I make a formal request to this organization that I no longer wish to participate in Charity Tracker.

By checking this box you agree to the above terms.

Description

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Mission House Registration Form

Description

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