Eastmont Women's Group Facilitator & Host Form

Your name *

Last name

Email address *

Phone number *

min: 10

Phone number *

Phone type

MobileHomeWorkOther

Birthdate *

Are you employed or attending school? *

Yes

No

Background Check

Have you ever been convicted of a criminal offense? *

Yes

No

Do you agree to have a background check completed by Eastmont Church? *

Yes

No

Reference 1

Full Name *

Email *

Phone Number *

Relationship to you *

Reference 2

Full Name *

Email *

Phone number *

Relationship to you *

Tell us about the last two churches you have attended and your reason for leaving *

Is Eastmont your home church? *

Yes

No

How long have you attended Eastmont? *

Which service do you regularly attend? *

Select…Saturday 5:00pmSunday 8:00amSunday 9:45amSunday 11:30am

Children's (if any) names and ages *

Address *

HomeWorkOther

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

How often are you in the Word? *

Tell us a little about yourself *

Which best describes you? *

Select…MarriedSingleDivorcedWidowEngaged

Spouse's name (If married) *

Have you volunteered at Eastmont? *

Yes

No

Which roles would you like to fill? (Select all that apply) *

Facilitator

Host

What days and times would you be available to meet weekly with your group? *

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