La Habra Christian Church
Sharing Jesus By Caring For People
Response Form

Please feel free to use this form to communicate with our church staff.

   Please check here if this is an address change

 Name
 
 Address
 

 City
  		 State
 Zip Code
 
 Telephone
 
 Email
 
 Age
 13-17
 18-22
 23-30
 31-40
 41-50
 51-60
 61-70
 71+ 		  Online guest
  First-time guest
  Second-time Guest
  Occasional attender
  Regular attender
  Member
  In area temporarily
  New resident

 Grade
 
 School
 

  Married     Single

 Number of Children
 
 Age of Children
 

   I would like to attend the next Membership 101 class.
   I am interested in becoming a Christian and/or being baptized.
   I have questions for a pastor or volunteer minister about the Christian faith.