Poplar Springs Christian Church YOUTH MINISTRY Survey 2022

1. (Q1.) Name of PARENT/GAURDIAN of Youth ages (2-18 years of age). Please share your Contact Details: *This question is required.

Space Cell	First Name	Last Name	Mobile Phone	Email Address	Home Phone	Address	City	ZIp
Parent/Gaurdian's Contact Details:	Parent/Gaurdian's Contact Details:: First Name	Parent/Gaurdian's Contact Details:: Last Name	Parent/Gaurdian's Contact Details:: Mobile Phone	Parent/Gaurdian's Contact Details:: Email Address	Parent/Gaurdian's Contact Details:: Home Phone	Parent/Gaurdian's Contact Details:: Address	Parent/Gaurdian's Contact Details:: City	Parent/Gaurdian's Contact Details:: ZIp

3. (Q3.) YOUTH or Parents/Guardians of youth, please provide Youth Contact Details below:
(Parent/ Guardian of more than one youth, please share available details below)

Space Cell	First Name	Last Name	Mobile Phone:	Email Address:	Age:	Birth (Day/Month)	Interest in Youth Ministry:	Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 1	Youth 1: First Name	Youth 1: Last Name	Youth 1: Mobile Phone:	Youth 1: Email Address:	Youth 1: Age:	Youth 1: Birth (Day/Month)	Youth 1: Interest in Youth Ministry:	Youth 1: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 2	Youth 2: First Name	Youth 2: Last Name	Youth 2: Mobile Phone:	Youth 2: Email Address:	Youth 2: Age:	Youth 2: Birth (Day/Month)	Youth 2: Interest in Youth Ministry:	Youth 2: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 3	Youth 3: First Name	Youth 3: Last Name	Youth 3: Mobile Phone:	Youth 3: Email Address:	Youth 3: Age:	Youth 3: Birth (Day/Month)	Youth 3: Interest in Youth Ministry:	Youth 3: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)

4. (Q4.) Parents/Guardians if you would like to provide updated contact details for 4 or more youth, please provide Youth Contact Details below. If not please SKIP Question #4.

Space Cell	First Name	Last Name	Mobile Phone:	Email Address:	Age:	Birth (Day/Month)	Interest in Youth Ministry:	Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 1	Youth 1: First Name	Youth 1: Last Name	Youth 1: Mobile Phone:	Youth 1: Email Address:	Youth 1: Age:	Youth 1: Birth (Day/Month)	Youth 1: Interest in Youth Ministry:	Youth 1: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 2	Youth 2: First Name	Youth 2: Last Name	Youth 2: Mobile Phone:	Youth 2: Email Address:	Youth 2: Age:	Youth 2: Birth (Day/Month)	Youth 2: Interest in Youth Ministry:	Youth 2: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)
Youth 3	Youth 3: First Name	Youth 3: Last Name	Youth 3: Mobile Phone:	Youth 3: Email Address:	Youth 3: Age:	Youth 3: Birth (Day/Month)	Youth 3: Interest in Youth Ministry:	Youth 3: Social Media Handles: (IG, SnapChat, FaceBook, LI, ect..)

4. (Q4.)Youth and/or Parents/Guardians of youth between the ages 2-18 years of age, are you interested in being contacted with updates, planning, and actively participating in Poplar Spring Christian Church Youth Ministry Programs? *This question is required.

Please enter an 'other' value for this selection.

5. (Q5.) Youth, what 3 topics would you like the Youth Minister, Youth Leader, and Youth Workers of Poplar Springs Christian Church to address?

Youth Spiritual Wellness
Youth Service and Volunteer Opportunities
Mental Health
Food Insecurities
Health and Wellness
Gangs and Violence
Bullying/Cyberbullying
Other-Please explain: Please enter an 'other' value for this selection.

6. (Q6.)What type of Youth Ministry programs and services are you interested in being a part of?

7. (Q7.) Are you a member of Poplar Springs Christian Church?