LIFE GROUPS
PARTICIPANT FORM
(Please complete in its entirety)
GENERAL INFORMATION
First Name
Last Name
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Email
Phone Number
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd rather not say
Spouse's First Name
Spouse's Last Name
Spouse's Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
CHILDREN INFORMATION
Do you have children under the age of 18?
Yes
No
Please enter the first and last names of all children under 18. Include their age, grade, and any special needs they may have.
If you have children, would you like to be part of a Life Group that offers childcare?
Yes
No
PREFERENCES
The following best describes the type of Life Group I would like to participate in:
Members are of a similar age/life stage/background as me
Members are of all ages/life stages/backgrounds
What, if any, is your prior experience with a church small group, either as a leader or a participant?
What are you hoping/expecting to get out of being a part of a Life Group?
I would be interested in attending a Life Group on the following day(s) of the week: (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I would be interested in attending a Life Group that met at the following time(s): (Check all that apply)
Morning (Before 12 PM)
Afternoon (12 PM–6 PM)
Evening (6 PM on)
I would be interested in attending a Life Group that meets as often as: (Check all that apply)
Once a week
Every other week
Once a month
Please list any allergies (plant/pet/food/etc.) you might have that could hinder your ability to participate in a Life Group:
PARTICIPANT HOSTING QUESTIONNAIRE
The following best describes my ability to host a Life Group in my home: (As able, we strongly encourage Life Groups to meet in the leader’s or a group member’s home)
I am open and willing to host a Life Group in my home
I am unable to host a Life Group in my home
How many adults can you reasonably and comfortably host in your home?
Less than 5
5-10
10-15
15+
Are you able/willing to assist in organizing childcare for your Life Group?
Yes
No
Do you have a separate and safe environment to host childcare available in your home?
Yes
No
Do you have pets?
Yes
No
If yes, what kind?
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