Connection Form

Connection Form

We would LOVE to stay connected with you!
Name *

First Name Last Name
Names of family members attending with me
I am a: *

Member Regular Attendee Visitor (Please share your contact info below)
I am submitting this form because:

ATTENDANCE: I attended the worship service today ADDRESS/PHONE: I have new info for your records PHOTO: I have a new photo for the directory NEWSLETTER: I'd like to receive the Email Newsletter (sent Wednesdays) PRAYER CHAIN: I'd like to receive the daily prayer requests via email so that I can pray for them PRAYER REQUEST: Please pray for me (details listed below) PASTORAL CALL: Please have a pastor contact me COUNSELING: I would like more info about receiving counseling KNOWING CHRIST: I would like more info about how to begin a relationship with Jesus Christ BAPTISM: I would like to get baptized CHILD DEDICATION: I would like to get my child dedicated MEMBERSHIP: I'd like to become a member of this church SMALL GROUP: I would like to join a Kinship Group or Bible Study SERVING: I would like more info about ways to serve
DIRECTORY PHOTO: add/update my family's photo(s)

Browse Files
click here to attach photo file Cancel of
I heard about Ebenezer Bible Fellowship Church from:
Email *
example@example.com
Primary Phone Number

Area Code Phone Number
Primary Phone Type
Please Choose
Alt Phone Number

Area Code Phone Number
Alt Phone Type
Please Choose
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date

Month Day Year
Grade in School (If applicable)
Wedding Date (If applicable)

Month Day Year
I would like to add information for my:

Spouse Children
How Many Children? *
SPOUSE'S INFORMATION
Spouse's Name *

First Name Last Name
Spouse's Email
example@example.com
Spouse's Cell Phone Number

Area Code Phone Number
Spouse's Birth Date

Month Day Year
Date
CHILDREN'S INFORMATION
Name - Child #1 *

First Name Last Name
Birth Date - Child #1

Month Day Year
Date
Email - Child #1
example@example.com
Cell Phone Number - Child #1

Area Code Phone Number
Name - Child #2 *

First Name Last Name
Birth Date - Child #2

Month Day Year
Date
Email - Child #2
example@example.com
Cell Phone Number - Child #2

Area Code Phone Number
Name - Child #3 *

First Name Last Name
Birth Date - Child #3

Month Day Year
Date
Email - Child #3
example@example.com
Cell Phone Number - Child #3

Area Code Phone Number
Name - Child #4 *

First Name Last Name
Birth Date - Child #4

Month Day Year
Date
Email - Child #4
example@example.com
Cell Phone Number - Child #4

Area Code Phone Number
Name - Child #5 *

First Name Last Name
Birth Date - Child #5

Month Day Year
Date
Email - Child #5
example@example.com
Cell Phone Number - Child #5

Area Code Phone Number
Name - Child #6 *

First Name Last Name
Birth Date - Child #6

Month Day Year
Date
Email - Child #6
example@example.com
Cell Phone Number - Child #6

Area Code Phone Number
Comments/Questions/Prayer Requests:
Should be Empty: