Get Connected

This form only needs to be filled out one time when you are new at Real Life, or to update your contact information when it changes. All information is kept confidential and will never be sold or distributed to a third party.

I am filling out this form because… *
Campus Attended *
Name *
Name
Preferred Phone *
Preferred Phone
Phone Type
Date of Birth
Date of Birth
This information is used to provide you with relevant information. (For example, if we know you are a high school student, we can send information specific to CRUX, our high school ministry.)
Address
Address
Spouse
Spouse
If last name is the same, only first name is required.
Date of Birth
Date of Birth
Child
Child
Date of Birth
Date of Birth
First name, last name (if different), and date of birth.
I’d like more information about…
Please select all that apply.