Get Connected Form

NEEDHELP

INPERSON

CONTACT

We Would Love to Connect With You!

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

Marital Status*

Married
Widowed
Divorced
Single

Date of Birth*

MM

DD

YYYY

Other Details

Address*

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

Phone

Email*

Please update my contact information

Do you have a church home?*

Yes
No

I attend*

James River Church
Other

What church do you attend?*

I am looking for a church home.

Which Campus*

Family Information

Spouse's Name*

First Last

Spouse's Date of Birth*

MM

DD

YYYY

Do you have children?

Yes
No

Child Information*

First Name	Last Name	Birthday (mm/dd/yyyy)	Grade	Relationship to You

Please list any children you have with you, their birthdate and their grades. If they are not in school, type N/A.

This is my first time to visit
I have been attending for awhile
I am looking for a church home
I already have a church home
Please update my information

How long have you been attending?

Additional Information/How Can We Help You

I would like more info about:

Becoming a Christian
Getting Baptized
I would like to share a Praise Report/Prayer Request
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*

Section Break

Please share your question*

Comments

Name

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