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 20-2425-3031-3536-4445-5555+Children YESNOAges of Children (Please Check All That Apply)0-3 Years4-6 Years7-10 Years11-13 Years14- 18 Years
Would you prefer to be in a singles Life Group? NoYes
Are you or your children allergic to pets? YesNo
Which night of the week works best for you to attend a small group? (Please choose one)MondayTuesdayWednesdayThursdayFridaySunday
Are you willing to host a group in your home? YESNO
Are you willing to lead a group? YESNO
Do you have any comments or questions?