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Fall 24 Questionnaire & Registration

Please complete the questionnaire for participation in the Fall 24 semester of Re|Engage

Husband FIRST & LAST NAME(Required)
Wife FIRST & LAST NAME(Required)
Times Married -- Husband(Required)
Times Married -- Wife(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Honestly rate your marriage on a scale of 1 - 10 (10 being highest)
012345678910
Honestly rate your marriage on a scale of 1 - 10 (10 being highest)
012345678910
Please enter his cell phone number
Please enter his cell phone number
Please enter his email address
Please enter her email address
KIDS YOU’RE BRINGING:(Required)
Please list the names (and ages/grades) of all kids you will bring with you on Wednesdays--all children will attend age-appropriate programming provided for them in their ministry areas.
Please enter the name of the church you consider to be your church home