2023 CoC TEAM APPLICATION

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Please complete the following information

First Name of Primary Contact

Last Name

Address

City

State

Zip/Postal Code

Your email address will automatically be added to our Lighthouse Newsletter list. Please type OPT-OUT in the field below if you do not wish to be added to the list

Do you have a smartphone?

YesNo

Cell Phone

Home Phone

Birthday

Gender

MaleFemale

Marital Status

Is there a second adult in your home?

YesNo

Adult 2 Information

First Name

Last Name

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Cell Phone (if different)

Birthday

Gender

MaleFemale

Marital Status

Children?

Do you have children living in your home?

YesNo

Please provide the following information for each child

First Name

Last Name

Birthday

Gender

MaleFemale

Will this child be serving with you?

YesNo

To add another child, click on "Add another response" above.

Family Information

How did you hear about the Lighthouse Community of Care Program?

Other (please specify:

Are you the assigned Care Team Lead for your group ?

YesNo

Are you signing up to be on a Care Team with a specific group ?

YesNo

Please enter your Care Team Lead's First Name

Please enter your Care Team Lead's Last Name

Have you attended a Lighthouse Family Retreat?

YesNo

Which type of retreat(s) have you attended?

Please share some details about your family's other volunteer experiences (if applicable).

Do you attend a local church?

YesNo

Name of Your Church

Please share your family's faith journey.

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Contact Information