St. Demetrios 2010 Questionnaire

Section A
Surname:*
First Name:*
Middle Name:
Address:*
Apt #
City:*
Province/State:*
County:*
Postal Code/Zip:*
Contact Number (residence):
Contact Number (other):
Email:*
Country:*
Date of Birth:*
Age:*
Marital Status:*
Occupation:*
Are you Baptised in the Orthodox Faith?*
If not, please indicate faith:
Were you married in the Orthodox Faith?*
If not, please indicate where marriage took place:
Last Name of Spouse:
First Name of Spouse:
Are you a Widow/Widower?
If yes, please enter date of decease:
Date of Marriage:
Name of Church & City:
Number of Children under 18:
Number of Children 18 and older:

SECTION B:
Spouse Applicant
Surname:
Middle Name:
First Name:
Address (if different from Section A above):
Appt #
City:
Province/State:
County:
Postal Code/Zip:
Contact Number (residence):
Contact Number (other):
Email:
Country:
Date of Birth:
Age:
Occupation:
Are you Baptised in the Orthodox Faith?
If not, please indicate Faith:

SECTION C:
Child Application Part A (1) (children under the age of 18)
Name of Child (1):
Date of Birth:
Age:
Sex:
Baptised Orthodox:
Date of Baptism:
Name of School:
Grade:
School Contact Number:
Name of Contact:
Relation:
Contact Number:

SECTION C:
Child Application Part A (2 (children under the age of 18)
Name of Child (2):
Date of Birth:
Age:
Sex:
Baptised Orthodox:
Date of Baptism:
Name of School:
Grade:
School Contact Number:
Name of Contact:
Relation:
Contact Number:

Child Application Part A (3) (children under the age of 18)
Name of Child (3):
Date of Birth:
Sex:
Baptised Orthodox:
Date of Baptism:
Name of School:
Grade:
School Contact Number:
Name of Contact:
Name of Contact:
Relation:
Contact Number:

Child Application Part A (4) (children under the age of 18)
Name of Child (4):
Date of Birth:
Age:
Sex:
Baptised Orthodox:
Date of Baptism:
Name of School:
Grade:
School Contact Number:
Name of Contact:
Relation:
Contact Number:

Child Application Part B (1) (age 18 or older, still living with parents)
Name:
Address (if different from Section A above):
Date of Birth:
Age:
Baptised Orthodox:
Date of Baptism:
Marital Status:
if Married, please name spouse:

If you are currently a student or a graduate please complete the following:
Name of University or College:
Program:
Academic Year:
Degree / Diploma / Certificate Obtained:

If you are not a student please complete the following:
Occupation:
Position:
Name and Location of Business:

Child Application Part B (2) (age 18 or older, still living with parents)
Name (2):
Address (if different from Section A above):
Date of Birth:
Age:
Sex:
Baptised Orthodox:
Date of Baptism:
Marital Status:
If married, please name spouse:

If you are currently a student or a graduate please complete the following:
Name of University or College:
Program:
Academic Year:
Degree / Diploma / Certificate Obtained:

If you are not a student please complete the following:
Occupation:
Position:
Name and Location of Business:

Child Application Part B (3) (age 18 or older, still living with parents)
Name (3):
Address (if different from Section A above):
Date of Birth:
Age9:
Sex:
Baptised Orthodox:
Date of Baptism:
Marital Status:
If married, please name spouse:

If you are currently a student or a graduate please complete the following:
Name of University or College:
Program:
Academic Year:
Degree / Diploma / Certificate Obtained:

If you are not a student please complete the following:
Occupation:
Position:
Name and Location of Business:

Child Application Part B (4) (age 18 or older, still living with parents)
Name:
Address (if different from Section A above):
Date of Birth:
Age:
Sex:
Baptised Orthodox:
Date of Baptism:
Marital Status:
If married, please name spouse:

If you are currently a student or a graduate please complete the following:
Name of University or College:
Program:
Academic Year:
Degree / Diploma / Certificate Obtained:

If you are not a student please complete the following:
Occupation:
Position:
Name and Location of Business: