ChurchFamilyHealth.com

Family Health Assessment Registration Form * denotes a required field
*Full Church name:
*Denomination:
*Street Address:
*City:
*State:
*Zip:	-
Mailing Address: Same as street address
Mailing Address:
City:
State:
Zip:	-

*Phone:	() - -
Fax:	() - -
*Church Contact [First Name] [Last Name]:
*Church Contact Title:
*Email (where assessment results will be sent):	(EX JohnDoe@aol.com)
*Confirm Email
Website:
*Year church was established:	( Must be Numeric )
*Senior pastor [First Name] [Last Name]:
*Average weekly attendance of adults:	( Must be Numeric )
*Number of worship services per weekend:	( Must be Numeric )
*Number of paid staff:	( Must be Numeric )
*Total annual budget:
*How did you hear about this survey?:
*Date Survey will be available:(MM/DD/YYYY)	Choose date
*Date Survey will be closed:(MM/DD/YYYY)	Choose date
Each survey participant will see the following greeting and brief instructions prior to beginning the survey. Please take a moment to personalize the closing at the bottom (you may add/edit as you like). Welcome! Thank you for taking the time to participate in this survey. This exercise will help us get an honest appraisal of the family units in our church body. As a result, we'll know where we need to apply intentional focus and openness to God's continued shaping of our ministry. Please try to answer each question candidly and honestly. Your first reaction is usually best so try to move swiftly through the assessment without bogging down and overanalyzing your responses. This should take approximately 15 minutes to complete. Be assured that your responses will be kept strictly confidential and at no point will your name be associated with your responses. IMPORTANT: Do not use the browser's BACK button during the survey. Doing so may lock up your computer. Gratefully in Christ, The Leadership Team [Your Church Name Here]
In order to keep your survey secure, please pick two separate passwords. One for your pastors and the other for your congregation. Don't worry, these will be emailed to you in a confirmation email.
*Pastor password:
*Congregation password:
Release of Data for Aggregated Research Your church's data will be combined into an international aggregate database of all churches that have participated in the assessment process. This database enables us to study macro level trends in denominations, generational categories, geographic regions, etc. All data will be kept strictly confidential. At no point will your individual churches data be singled out or made available to the public. We do not sell or share our mailing list.
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* denotes a required field