Life Group Questionnaire

Name * First Last

Spouse's Name (If applicable) First Last

Email *

Type of group I am interested in (check all that apply) *

Men Women Couples Young Adults Young Marrieds Single/Divorced/Widowed Single Parents 30's & 40's 50+ Surfers Other

If you selected "other," please let us know what you are looking for in the comments box at the end of this questionnaire.

Preferred Day of the Week

Second Choice - Day of the Week

Children *

No children We have children, but they will not be at the group Our children will be at the group but they will not require supervision Our children will be at the group and they will require supervision

If you do have children, please use the comment box below to let us know how many you have and how old they are.

Preferred Location (check all that apply) *

North Carlsbad South Carlsbad/La Costa Encinitas North Oceanside Oceanside/Tri-City Other No Preference

If you select "other," please use the comments box at the bottom of the questionnaire to let us know where you are looking for a Life Group.

Willing to lead or host a group? (Potential leaders will be interviewed by Daybreak staff) *

Interested in hosting and leading Interested in hosting Interested in leading Not at this time

Comments and Questions:

Wufoo