Digital Connect Card

Name*

First Last

Address*

Street Address City State ZIP Code

Email*

May we include you in our email communication?

Permission to add me to email communications
Not at this time

Phone*

Birthdate

Involvement:*

First time here
Second time here
Regular Attender
Member
Other

Other?

Check all that apply to your family:

Nursery - Elementary
Middle - High School
Adults

I have a spouse

Yes
No

Spouse's Name

First Last

Spouse's Birthdate

Spouse attends with me

Yes
Not at this time

Spouse's Address

Same address as above
Different address from above

Spouse's Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse's Email

Spouse's Phone

Spouse's Phone type

Cell
Work
Home

I have a child

Yes
No

Child attends with me

Yes
Not at this time

Child's Name

First Last

Child's Birthdate

Child's Address

Same address as above
Same address as spouse
Different address

Child's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage

Nursery - Elementary
Middle - High School
Adult

+ Add a 2nd child

Yes

2nd Child attends with me

Yes
Not at this time

Child's Name (2)

First Last

Child's Birthdate (2)

Child's Address (2)

Same address as above
Same address as spouse
Same address as Child (1)
Different address

Child's Address (2)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (2)

Nursery - Elementary
Middle - High School
Adult

+ Add a 3rd child

Yes

3rd Child attends with me

Yes
Not at this time

Child's Name (3)

First Last

Child's Birthdate (3)

Child's Address (3)

Same address as above
Same address as spouse
Same address as Child (1)
Same address as Child (2)
Different address

Child's Address (3)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (3)

Nursery - Elementary
Middle - High School
Adult

+ Add a 4th child

Yes

4th Child attends with me

Yes
Not at this time

Child's Name (4)

First Last

Child's Birthdate (4)

Child's Address (4)

Same address as above
Same address as spouse
Same address as Child (1)
Same address as Child (2)
Same address as Child (3)
Different address

Child's Address (4)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (4)

Nursery - Elementary
Middle - High School
Adult

+ Add a 5th child

Yes

5th Child attends with me

Yes
Not at this time

Child's Name (5)

First Last

Child's Birthdate (5)

Child's Address (5)

Same address as above
Same address as spouse
Same address as Child (1)
Same address as Child (2)
Same address as Child (3)
Same address as Child (4)
Different address

Child's Address (5)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (5)

Nursery - Elementary
Middle - High School
Adult

+ Add a 6th child

Yes

6th Child attends with me

Yes
Not at this time

Child's Name (6)

First Last

Child's Birthdate (6)

Child's Address (6)

Same address as above
Same address as spouse
Same address as Child (1)
Same address as Child (2)
Same address as Child (3)
Same address as Child (4)
Same address as Child (5)
Different address

Child's Address (6)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (6)

Nursery - Elementary
Middle - High School
Adult

+ Add a 7th child

Yes

7th Child attends with me

Yes
Not at this time

Child's Name (7)

First Last

Child's Birthdate (7)

Child's Address (7)

Same address as above
Same address as spouse
Different address

Child's Address (7)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's stage (7)

Nursery - Elementary
Middle - High School
Adult

Can we help you know more or get connected?

Yes

Info/Connect

Knowing more about Jesus
Being Baptized
Connecting with a Group
Serving in the Church or Community
Other

Describe other:

I have a prayer request

Yes

I would like prayer for:

Prayer Request Confidentiality

Confidential
Public

Comment

If you fill out the Connect Card below, we will donate $5 to help feed the hungry in Gwinnett County

Digital Connect Card