Church Disciplinary Action Form

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2:14-16 publically Unresolved Matthew 18:15-20 Private reproof Restoration personal conflicts Private discussion Reconciliation Public announcement Removal, no association Rock Church Discipline, Restoration and Reconciliation Today s Date // Name DOB // Address City State Zip Primary phone ( ) Secondary () Email: If no permanent address, where are you staying Specific history and narrative of the incident (include dates where relevant):

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