New Here Form • Impact Church

First Name *

Last Name *

Home Address

Home Province

Home Postal Code

Phone Number

Email Address

Date of Birth

Do you currently belong to a church?

Yes

No

If yes, what church?

How did you hear about Impact Church?

I would like more information about:

Accepting Jesus

Next Steps

Small Groups

Children's Ministry

Serve Teams

Community Outreaches

Water Baptism

Child Dedication

Prayer MInistry

Pastoral Care

Other (Please explain below)

Other (please explain):

At Impact Church we believe that 'Generosity is our Privilege'! Aligning with this core value, we would love to support one of Cochrane's local charities by donating to them $5 in your name, simply by filling out this form. Supporting charities is something that we do every month and we'd love to include you in that process!

Please Select from one of the following charities for us to donate $5 in your name

Prayer Request: