First Name *

Last Name *

Email Address *

Home Suburb *

Phone Number

What age group are you in? *

Date of Birth

School Grade

School

Emergency Contact Name

Emergency Contact Phone Number

Which of the following options best represents your experience with Christianity?

Is there anyone that, if possible, you would like to be in a group with?

Tip: Unfortunately we cannot promise we can get everyone you'd like in a group with you but we'll do our best.

When are you available to attend a Life Group meeting during an average week?

Tip: List weekdays, weeknights, weekends that would work for you, and morning, afternoons or evenings.

Would be interested to host a Life Group at your house? (Checking yes is an initial indication only, not a concrete commitment.)

Anything else you'd like to let us know?