Ride Request Form for Van Ministry

We are so happy to have you at Life in Christ church!

Please fill out the information below in order to help receive a ride to church. Once submitted, you will receive a text message with additional information.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date requested for pick up?

MonthDayYear
Date
Number of passengers (including yourself)?
Special Requests
Space for car/booster seat, small walker, etc. (not provided)
Consent

I voluntarily give permission for Life in Christ Church (LICC) members to transport me and/or my family to and from church.
Signature
Should be Empty: