Mississippi Conference
Christian Parenting & Caregivers Cohort
*First Name
*Last Name
*Address 1
*City
*State
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US Armed Forces - Americas
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*Zip
*Phone
*Email
Spouse/Partner (if applicable)
Name and age(s) of your child(ren)
*
Which Cohort are you interested in joining?
Aldersgate
Galloway
St. Luke's
Does not matter
*
What is your age?
18 - 25
26 - 35
36 - 45
45 - 54
Other
What is your biggest motivation to join the Christian Parenting and Garegivers Initiative?
Do you attend a church, if so, what is the name?
*
What is your relationship to your child(ren)?
Please check all that apply.
Parent
Step-parent
Grandparent
Aunt/Uncle
Foster Parent
Adoptive Parent
Sister/Brother
Other
*Will you be needing childcare for the peer group meetings?
Yes
No
*
What day of the week would you prefer to meet?
Check all that apply.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
*
What time of day would be best for you to attend?
Check all that apply.
Morning
Afternoon
Evening
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