Digital New Here Card • Connexus Church

Digital New Here Card

Your Information

First Name *

Middle Name or Initial (if any)

Last Name *

Location I am attending today: *

Barrie

Orillia

Online Only

Contact Information

Email Address *

Preferred Phone Number

Our Lead Pastor often sends emails with encouragement, information and helpful resources. Would you like to be added to this mailing list? *

Yes please

No thanks

Tip: You are able to unsubscribe at any time

Your Address Details

Our team would love to send you a card to say thanks for joining us.

Address Line

City / Town

Province / State

Postal / Zip Code

I would describe myself as:

How often would you usually attend church?

I have come with:

Friend's Name

Partner's First Name

Partner's Last Name

I have come with children today. *

Yes

No

How many children would you like to register? *

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

Child's Full Name *

Date Of Birth *

If your child is in diapers, do you give us permission to change them? *

Gender

Any health concerns or allergies?

If you are giving us your children's details, please read below.

I grant Connexus Community Church, its representatives, and employees the right to take photographs, videos, and/or electronic images of any member of my family in the WaumbaLand and UpStreet environments. I authorize Connexus Community Church to copyright, use, and publish the photographs, videos, and/or electronic images in print and/or electronically - with or without names - for any lawful purpose to highlight and promote WaumbaLand and UpStreet environments. By checking the box below, I am indicating that I have read and understand the above statement of release.

I have read the above media release and give my consent on behalf of my children. *