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INPERSON

CONTACT

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How Can We Help You?

In-Person Info

IP_ADDRESS

Which campus are you attending?*

South
West
North
Joplin

Your Details

Your Name*

First Last

Gender*

Male
Female

Date of Birth*

MM

DD

YYYY

Other Details

Phone

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please update my contact information

Marital Status*

Married
Widowed
Divorced
Single

Spouse's Name*

First Last

Spouse's Date of Birth*

MM

DD

YYYY

Spouse's Gender*

Male
Female

Do you have a church home?*

Yes
No
I am looking for a church home

I attend*

James River Church
Other

Which Campus*

How long have you been attending?

Additional Information/How Can We Help You

I would like more info about:

Becoming a Christian
Getting Baptized
Life Groups
Joining a Dream Team (Volunteering)
Counseling
I have a question

Life Event/Hospitalization:

I am currently in the hospital
I have an upcoming surgery
Birth of Baby
Death in Family
Emergency Situation
Other

Prayer Request

I would like to share...*

Praise Report
Prayer Request

Would you like for someone to call and pray with you?*

Yes
No

Please Share Your Prayer Request*

Praise Report

Please Share Your Praise Report*

Life Groups

To get connected to a Life Group, click here!

Recent Hospitalization

Date of Hospitalization*

MM

DD

YYYY

Hospital Location*

Circumstance of Hospitalization*

Upcoming Surgery

Date of Surgery*

MM

DD

YYYY

Hospital Location*

Type of Surgery*

Other

If you need immediate assistance please call the church at 417-581-5433.

Please Give Us Details*

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Please share your question*

Comments

Email

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