Congregation & Ministry Supporters Intake Form

Congregation & Ministry Supporters Intake Form
Contact Information:
Full Name*

First NameLast Name
Phone Number*

Country CodePhone Number
Date of Birth

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Primary Church*
Church City*
Family Information:
Family Members
Service Information:
Do you live in Georgina Ontario, or the surrounding areas?*
Are you or family planning to relocate to Georgina or the surrounding areas in the next 5-10 years?*
Please Specify Which Family Member*
Are you willing to support our new ministry?*
How are you able to help? (Select All That Apply)*

In-Person ServiceRemote ServiceFinancial ContributionsFood PreparationIn-Person MissionaryOther
What can you help with? (List all that apply)*
Are you willing to serve the underserved? *
Type of outreach (Select all that apply)*

First Nation CommunitiesPeople with Disabilities (such as Autism and Down Syndrome)The Socially IsolatedThe ElderlyHomeless ServiceAll of the above
What are you and your family missing to fulfill your spiritual needs?
What are you looking for in our new ministry?
Additional Comments or Suggestions (if any) for Ministry Improvement:
Should be Empty:

Contact Information: