Communication Consent Form
Please add me to The Life Church Christian Center's communication system.
Date
*
-
Month
-
Day
Year
Do you give your Consent to receive Text Messaging from The Life Church Christian Center?
*
YES
NO
Do you give your Consent to receive Email communication from The Life Church Christian Center?
*
YES
NO
Do you give your Consent to receive Automated Voice Message communication from The Life Church Christian Center?
*
YES
NO
Do you understand that you can OPT Out of receiving Text or Email communication at any time by replying with STOP?
*
YES
NO
Please Select One:
*
I am a Member of The Life Church Christian Center
I am a Guest
Your Name
*
First Name
Last Name
Phone Number
*
Your Email
*
example@example.com
Address (Optional)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthday (Optional)
-
Month
-
Day
Year
Date
Gender (Optional)
Male
Female
Marital Status (Optional)
Single
Married
Divorced
Widowed
Please List the Name and Age of Minor Children:
(If Applicable)
Minor Child
First Name
Last Name
Age
Minor Child
First Name
Last Name
Age
Minor Child
First Name
Last Name
Age
Minor Child
First Name
Last Name
Age
Age
SUBMIT
Should be Empty: