What is Age Range of your Child/ren *

Select all that apply

Infant

Toddler (1-2 years old)

PreK (3-4 year old)

K-2nd Grade

3rd-5th Grade

Middle School

Is Your Child Involved in Any of the Following

Select all that apply

Public School

Home School

Sports

Music / Dance

Scouts

Church Programs (outside Sunday)

What Spiritual Disciplines Do You Do As A Family

Select all that apply

Bible Reading

Listen to Christian Radio

Watch Christian TV / Movies

Prayer at Meal and/or bedtime

Other

Do Any of the Following Activities Interest You or Your Child?

Select all that apply

Field Trips

Kids Performace During Church Service

Awana

VBS / Sports Camp

Fall Festival / Truck or Treat

Easter Celebration / Egg Hunt

Pizza / Movie Night

How Often Are You, The Parent, Available to Make This Happen?

Select all that apply

Sorry, my schedule is crazy, but thank you for all you do

Once a month

4-8 times a year

Weekly

For Special Events / Activities

Name

First Name

Last Name

Phone

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