SHINE // A Jesus Church Connect Card

Shine // A Jesus Church Connect Card

We are so glad you are here!
I'm New to SHINE*

YesNo, we have been attending for a whileJust updating our info
I'm New to SHINE*

YesNo, we have been attending for a whileJust updating our info
Adult 1*

First NameLast Name
Adult 1 Email*
example@example.com
Adult 1 Phone Number*
Please enter a valid phone number.
Adult 1 Birthdate*

MonthDayYear
Date
Adult 2 Name

First NameLast Name
Adult 2 Email
example@example.com
Adult 2 Phone Number
Please enter a valid phone number.
Adult 2 Birthdate

MonthDayYear
Date
Address of Family*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Children's/Youth info below

Please fill out for your children that are under 18 and live in the home with you. Thank you
Child Name

First NameLast Name
Phone Number for Youth Student if applicable
Please enter a valid phone number.
Birthdate

MonthDayYear
Date
Grade
Gender

MaleFemale
Do they have any allergies/ medical conditions we should know about?
Child Name

First NameLast Name
Phone Number for Youth Student if applicable
Please enter a valid phone number.
Birthdate

MonthDayYear
Date
Grade
Gender

MaleFemale
Do they have any allergies/ medical conditions we should know about?
Child Name

First NameLast Name
Phone Number for Youth Student if applicable
Please enter a valid phone number.
Birthdate

MonthDayYear
Date
Grade
Gender

MaleFemale
Do they have any allergies/ medical conditions we should know about?
Child Name

First NameLast Name
Phone Number for Youth Student if applicable
Please enter a valid phone number.
Birthdate

MonthDayYear
Date
Grade
Gender

MaleFemale
Do they have any allergies/ medical conditions we should know about?
Should be Empty:

Shine // A Jesus Church Connect Card

Children's/Youth info below