Acct. #		
Date entered		

ÑÔN GIA NHAÄP GIAÙO XÖÙ
GIAÙO XÖÙ THAÙNH TAÂM 
2121 N. DENTON DR.
CARROLLTON, TX 75006
972-446-3461

Title:  OÂng/Baø - Anh/Chò  - Mr./Mrs.	(Xin ñaùnh daáu neáu là teân Vieät Nam – Please use accent marks for Vietnamese name)
Teân Hoï - Last name:                                  ____ ___   Teân ñeäm - Middle name:                                        __   Teân - First name:                                               
Ñòa chæ – Address:                                                                                                                              ____________________________________________
Thaønh Phoá – City:                                         Tieåu Bang – State:                     Zip code:                                      Email:                                                         
Ñieän thoaïi – Phone No.:                                   (Nhà/Home)  Di Động – Mobile No.:                                         Công xưởng – Work No.:                                      

	Teân thaùnh 	Teân hoï
Last name	Teân ñeäm
Middle name	Teân
First name	Ngaøy sinh Birthday
(mm/dd/yy)	Röûa Toäi Baptism Yes / No	Röôùc Leã laàn ñaàu First Communion Yes / No 	Theâm söùc Confirmation Yes / No 	
Tröôûng gia ñình – Head of household									
Choàng / Vôï – Husband /  Wife									
Con : Trai / Gaùi – Son / Daughter									
Con : Trai / Gaùi – Son / Daughter									
Con : Trai / Gaùi – Son / Daughter									
Con : Trai / Gaùi – Son / Daughter									
Con : Trai / Gaùi – Son / Daughter									
Other : 									

Tình traïng gia caûnh:   Ñoäc thaân – Single:                    Coù gia ñình – Married:                  

Muoán tham gia: 	- Ñoïc thaùnh thö 	-Daïy Giaùo lyù 		  -Daïy Vieät ngöõ 		- Ban trang trí 		- Daâng hoa 
(voøng troøn ban 		- Ban baùo chí 		-Ban söûa chöûa 		  -Ban doïn deïp		- Ban aåm thöïc 		- Ban ñieän aûnh
 muoán tham gia)	- Ban caém hoa 		-Lieân Minh Thaùnh Taâm	  -Hoäi Caùc Baø Meï 	- Thanh nieân		- Ca ñoaøn (9:00am/11:00am)