Leader Name  * Street Address Address (cont.) City State Zip Code Home Phone  * Cell Phone E-mail (if you use) How long have you been attending our Church? Have you been to CCC Small Group Leader Orientation? Yes No Have you been involved in small groups at CCC before? Yes No Do you have a co-leader in mind to help lead this class? (please put name if you do) Name of Group or Connector:  * Brief Description of Group:  * This group is for (check all that apply) Activity/Special Interest Children Youth Connector Growth Healing Ladies Men Outreach Prayer Service Time you will meet (hh:mm AM/PM) Check which day(s) you will meet: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Frequency you will meet: Daily Weekly Every Other Week 2xs a Month Monthly Every Other Month Once a Semester Start Date: End Date: Meeting Location: I will need the following: Books Assistance taking pictures Building access (key) Childcare Reimbursement Sheets End-of-Group Evaluations Sound/Video Equipment Is your group: Open (people can attend at anytime) Closed (people can only start at the beginning of the class) Security code:   * Do not enter anything in this field:

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