EPIC YOUTH - Directory Update Form

The Church has a database of people who consider CityLife Church to be their home church, or (Youth Ministry) so that we can keep in touch with you. All the details you provide are for pastoral use only and are not available to the general public. Click here for a full version of our Privacy Policy.

First Name:
Surname:
Gender:	MaleFemale
Birthday:	/ /
Street Address:
Suburb:
Postcode:
Home Phone:	(03)
Mobile Phone:
Personal Email:
Country of Birth:
Name of School:
School Year level:

Approximate date of your first visit to Youth:
Do you live at home with:	Both ParentsOne Parent - FatherOne Parent - MotherOther
Do you come to CityLife on the weekends?	YesNo - Name of the church you attend (if applicable):
Previous Church (if applicable):
Do your parents attend CityLife Church?	YesNo churchAnother Church
Do they support your belief?	YesNo
Can we send mail to your parents?	YesNo
Can we contact you?	By mail: YesNo By phone: YesNo
Your Life Group Leader's name is:

I agree to these details being made available to CityLife Church Youth Department for Life Group listings and Pastoral Purposes only.