Pastoral Charge Information Form (2025)

Please complete and submit this Pastoral Charge Information Form each year after the annual meeting. This helps us keep the most up-to-date information about the pastoral charge on file.

Name of Pastoral Charge or Community of Faith (if a one-point charge)*
Name of Individual Submitting Information*
First Name Last Name
Phone of Individual Submitting Information*
Email of Individual Submitting Information*
A copy of the submitted form will be emailed to you.
Date of Annual Meeting
REMINDER: Please file a copy of your Annual Report with the office electronically by regular mail to : Info4RC14@united-church.ca
MM slash DD slash YYYY
Churches/Worship Points (Worship Point Accounts for Home Church Communities)
Halls
Cemeteries Managed by Community of Faith
Pastoral Charge Mailing Address*
Street Address Address Line 2 City Province Postal Code
Do you have a Manse?*
- Yes
- No
Manse Mailing Address*
Street Address Address Line 2 City Province Postal Code
Pastoral Charge Phone #*
Pastoral Charge Email Address*
Pastoral Charge Website
Pastoral Charge Facebook Name
Current Minister
First Name Last Name
Current Minister's Email Address
Do you have a second minister?*
- Yes
- No
Minister (Second)*
First Name Last Name
Minister's Email Address (Second)*
Board/Council Chair (or equivalent)
Name (Board/Council Chair (or equivalent))
First Name Last Name
Phone
Address
Street Address Address Line 2 City Province Postal Code
Email
Board/Council Secretary
Name (Board/Council Secretary)
First Name Last Name
Phone
Address
Street Address Address Line 2 City Province Postal Code
Email
Central Treasurer
Name (Central Treasurer)
First Name Last Name
Phone
Address
Street Address Address Line 2 City Province Postal Code
Email
Trustee Chair
Name (Trustee Chair)
First Name Last Name
Phone
Email
M&P Chairperson
Name (M&P Chairperson)
First Name Last Name
Phone
Email
Outreach Advocate
The person’s role is to disseminate information and education, as well as work with the Pastoral Charge Outreach Committee or equivalent to plan initiatives for the local Pastoral Charge.
Name (Outreach Advocate)
First Name Last Name
Phone
Email
Cemetery Chair
For points which no longer have a congregation
Name (Cemetery Chair)
First Name Last Name
Phone
Email
Elected Members and Alternates
Please list your elected members and alternates for Fundy St. Lawrence Dawning Waters Regional Council. Alternates must be from the same congregation
Do you have Elected Members?*
- Yes
- No
How many members are you entitled to? (In addition to your Minister)*
Member 1
Member 1 Name
First Name Last Name
Member 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 1 Phone
Member 1 Email
Member 1 Congregation
Is there an alternate for Member 1?*
- Yes
- No
Is there a Member 2?*
- Yes
- No
Alternate for Member 1
Alternate for Member 1 Name
First Name Last Name
Alternate for Member 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 1 Phone
Alternate for Member 1 Email
Alternate for Member 1 Congregation
Member 2
Member 2 Name
First Name Last Name
Member 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 2 Phone
Member 2 Email
Member 2 Congregation
Is there an alternate for Member 2?*
- Yes
- No
Is there a Member 3?*
- Yes
- No
Alternate for Member 2
Alternate for Member 2 Name
First Name Last Name
Alternate for Member 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 2 Phone
Alternate for Member 2 Email
Alternate for Member 2 Congregation
Member 3
Member 3 Name
First Name Last Name
Member 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 3 Phone
Member 3 Email
Member 3 Congregation
Is there an Alternate for Member 3?*
- Yes
- No
Is there a Member 4?*
- Yes
- No
Alternate for Member 3
Alternate for Member 3 Name
First Name Last Name
Alternate for Member 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 3 Phone
Alternate for Member 3 Email
Alternate for Member 3 Congregation
Member 4
Member 4 Name
First Name Last Name
Member 4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 4 Phone
Member 4 Email
Member 4 Congregation
Is there an Alternate for Member 4?*
- Yes
- No
Is there a Member 5?*
- Yes
- No
Alternate for Member 4
Alternate for Member 4 Name
First Name Last Name
Alternate for Member 4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 4 Phone
Alternate for Member 4 Email
Alternate for Member 4 Congregation
Member 5
Member 5 Name
First Name Last Name
Member 5 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 5 Phone
Member 5 Email
Member 5 Congregation
Is there an Alternate for Member 5?*
- Yes
- No
Is there a Member 6?*
- Yes
- No
Alternate for Member 5
Alternate for Member 5 Name
First Name Last Name
Alternate for Member 5 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 5 Email
Alternate for Member 5 Congregation
Member 6
Member 6 Name
First Name Last Name
Member 6 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member 6 Phone
Member 6 Email
Member 6 Congregation
Is there an Alternate Member for Member 6?*
- Yes
- No
Alternate for Member 6
Alternate for Member 6 Name
First Name Last Name
Alternate for Member 6 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate for Member 6 Phone
Alternate for Member 6 Email
Alternate for Member 6 Congregation
“The use, retention and disclosure of personal information collected from this form is done in compliance with privacy legislation including, but not limited to, the Personal Information Protection and Electronic Documents Act (2000, c.5).”

Pastoral Charge Information Form (2025)

Board/Council Chair (or equivalent)

Board/Council Secretary

Central Treasurer

Trustee Chair

M&P Chairperson

Outreach Advocate

Cemetery Chair

Elected Members and Alternates

Member 1

Alternate for Member 1

Member 2

Alternate for Member 2

Member 3

Alternate for Member 3

Member 4

Alternate for Member 4

Member 5

Alternate for Member 5

Member 6

Alternate for Member 6

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