Discipleship Program

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Personal Information

Name

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Address

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Phone

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Best Time to be Reached

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Date of Birth

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Age

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Email

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This address will receive a confirmation email

Member of Lake Shore

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Please select all that apply.

Member Regularly Attend

Number of Children (if any)

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Ages of Children (if any)

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Years a Christian

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Check all that apply

*

Please select all that apply.

Single Married Separated Divorced Widower Remarried College

Mentor or Be Mentored

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Please select one option.

Mentor Be Mentored

Background & History

List of bible studies or ministries you are or have been involved in.

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Brief testimony & religious background

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Interests, hobbies, talents & skills

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Please list any goals or expectations you have for a one-on-one discipleship relationship

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Please list any helpful information that we should consider when pairing individuals

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Description

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