Smokey Point Community Church

First Name
Last Name
Address
City
Daytime Phone
State
Zip
Evening Phone
Mobile Phone
Email
Age
Married or Single      Married Single
If married, will your spouse attend or just you?      both just me
Occupation

What days and times of the week do you prefer?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Evenings
Days

Do you need childcare?      Yes No
If you would like childcare, how many children do you have and what ages are they?

Type of group you prefer (check all that apply)
Parents with Children
Men's Group
Young and Married
Mid-Married
Senior Adults
Empty Nesters
Women's Group
New Christian
Mixed Group
Other (please describe)

Have you been in a small group before?      Yes No

What do you hope to experience in a Life Group?

= Required