Christ Church Online Connect Card

1
Is this your first time filling out our Connect Card?* This field is required.
YesNo
2
Your Name* This field is required.
First Name
Last Name
3
Your Email* This field is required.
example@example.com
4
What Is Your Phone Number?* This field is required.
Area Code
Phone Number
5
Where do you live?* This field is required.This will help us connect you with local ministries.
City
State
Zip Code
United States
Country
6
Do you have any children under 18?* This field is required.
Yes
No
7
List your children's names and birthdates* This field is required.Ex: Madison Smith, 04/04/2015
8
Please list your children's names and ages.Ex: Madison - age 6. Tyler - age 4
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9
How did you attend worship at Christ Church?* This field is required.
I attend Christ Church Fairview Heights Campus
I attend Christ Church Collinsville/Maryville Campus
I attend Christ Church Scott Campus
I watch on Facebook
I watch on Youtube
I watch on the Church Online Platform
I watch on my TV through the Boxcast App
10
How many are watching with you?* This field is required.
11
How did you find out about Christ Church?* This field is required.
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12
Do you have any questions for us?
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13
Please verify that you are human* This field is required.
Should be Empty: