Are you interested in being part of a small group in someone's home during this study? If so, please complete this form so we can place you in the best possible group for you and your entire family.


Name(s)

Street Address
City
State
Zip

Phone Number
Email Address


Age Range
Children
Ages of Children (Please Check All That Apply)
0-3 Years
4-6 Years
7-10 Years
11-13 Years
14- 18 Years

Would you prefer to be in a singles Life Group?

Are you or your children allergic to pets?

Which night of the week works best for you to attend a small group? (Please choose one)
Monday
Tuesday
Wednesday
Thursday
Friday
Sunday

Are you willing to host a group in your home?

Are you willing to lead a group?

Do you have any comments or questions?