Digital Connect Card

Date *

MM

DD

YYYY

Name *

Please share any additional names in the information box toward the bottom of the form.

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Please Check All That Apply to You:

New to the Beaver Dam area

First time viewing our online service

Would like to know more about Jesus

Would like Pastor to call/visit

Interested in baptism for my child

Interested in preschool and/or Sunday School

Looking for a church home

Prayer Request (Please share below)