Mentor Group Registration

Mentor Group Registration
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NOTE: This form must be completed in full before a mentor is assigned. Please use "N/A" for any fields that do not apply to you.
Personal Information
Name*

First NameLast Name
Preferred Name (if different)
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Age
Marital Status*
Phone Number*
Email*
example@example.com
Preferred Contact Method:*

Phone CallEmailText
Best time to reach you
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Religious Background
Which Church at The Mill Campus do you currently attend? (Please note that mentors are currently prioritized for Church at The Mill members and attendees).*

Central CampusLake Cooley CampusWoodruff CampusI do not currently attend Church at The Mill
How often do you attend per month, in person?*

01234+
Please select your membership status:*

Active MemberIn Membership ProcessRegular Attendee/Guest
Do you currently have a regular daily quiet time?*

YesNo
I have been in a one-on-one mentor / discipleship relationship before:*

YesNo
Briefly share why you would like to be mentored.*
Should be Empty:

Personal Information