Your name? *
First Name
Middle
Last Name
Spouse's Name?
First Name
Middle
Last Name
What is your address? *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Would your LifeGroup be held at your home?*
If not, who do you know that will be hosting the group?
What is your home phone number?
What is your mobile phone number?*
What is your email address?*
Marital Status? *
Do you have any kids?*
If yes, what are their names and ages? *
Please list and hobbies/interests you and your spouse may have. *
Do attend Benton First regularly?*
years attended?*
Are you currently involved in any other ministries at Benton First?*
If yes, what are those ministries?
Has anyone ever brought or threatened a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment? **
Have you been charged, arrested, or convicted of a felony? *
Is there anything in your past that might come up as a questionable issue? (i.e. pornography, sexual addiction)*
If yes, explain:
Is there a specific group of people or demographic which you would like to focus on (i.e., single parents, divorced/blended families, parents of kids with disabilities, etc.)? If so, explain: *
Do you have people in mind that you would like to invite to your group, or would you like the office to help you fill your group? *
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LifeGroups