Intake form

Name *

Email address *

What is your reason for visiting us?

Please select at least one option.

Worship Service

Community Event

Baptism

Wedding

Funeral

General Inquiry

How did you hear about us?

What is your preferred method of contact?

Would you like to participate in any community activities?

Please select at least one option.

Bible Study

Volunteering

Community Outreach

Choir

Youth Group

What age group do you belong to?

Do you have any specific prayer requests or needs?

Additional questions or comments

St Mary the Virgin, Amersham & All Saints’ Coleshill