BCUMC Participant Survey
All of us here at Berlin Center United Methodist Church want to have a meaningful relationship with God and one another. We ask that you take a few moments to provide some information about yourself and your family so that we can make informed decisions about future events and keep you up to date with the life of the church.
All the information gathered here will not be shared with any other organizations and will only be used to confirm, correct, or update what we already have on file.
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Full Name of Each Person Living at Home
Please Fill in the information for each person living in your household.
Email Address *
Adult 1: Name *
Adult 1: Phone Number *
Adult 1: Member of BCUMC? *
Adult 2: Name
Adult 2: Phone Number
Adult 2: Member of BCUMC?
Clear selection
Adult 3: Name
Adult 3: Phone Number
Adult 3: Member of BCUMC?
Adult 4: Name
Adult 4: Phone Number
Adult 4: Member of BCUMC?
Clear selection
Child 1 (Under 18): Name
Child 1 (Under 18): Age
Child 2 (Under 18): Name
Child 2 (Under 18): Age
Child 3 (Under 18): Name
Child 3 (Under 18): Age
Child 4 (Under 18): Name
Child 4 (Under 18): Age
Family Address *
If a family member has recently moved away from home, would you provide their name and new address?
Please give us some info about your connection to BCUMC. In the last six months: (Check all that apply) *
Required
Please tell us how you wish to receive communications from BCUMC. (Check all that apply) *
Required
Please tell us of the Small Groups you (or children) have attended in the past. (Check all that apply) *
Required
Please tell us about the things you find most meaningful at BCUMC: *
Are you willing to accept a leadership position in a specific ministry at BCUMC? What are you interested in doing?
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