Wednesday Night — Intentional Family – University Carillon Forms

Led by Pastor Craig Blocher & Jesse Bachman
7 weeks

Starting January 18

CONTACT INFO

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First Name *

Last Name *

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Phone

Cell *

Email *

Confirm Email

Which is your Primary Worship Community: *

ATTENDING ADULTS

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Number of Adults *

Name(s) of all those attending *

*PHOTO/VIDEO RELEASE

For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for University Carillon use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release: *

Given
Denied

*RELEASE

Submitting this on-line form will be the equivalent of signing a paper form.

I have read and understand the above information. The information I have given University Carillon is accurate and true to the best of my knowledge.
My electronic signature signifies my understanding that submitting this online form will be the equivalent of signing a paper form.

Release *

Yes, I Agree

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Electronic Signature *

Date Electronically Signed *