JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
a|CITY HEART | How can we help you?
Thank you for taking the time to let us know how we can help you. YOU MATTER.
Please indicate which area/ s we can assist you with and one of our incredible team members will be in contact with you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name:
*
Your answer
Surname:
*
Your answer
Mobile Contact Number:
*
Your answer
Age Group:
*
16-25
26-49
50-64
65+
Other:
Life Stage:
*
Student
Working Adult
Parent
Retired
Other:
Please Select:
*
I would like someone to contact me to PRAY WITH ME.
I need assistance with a FOOD PARCEL.
I need COUNSELLING.
I am seeking EMPLOYMENT.
Other:
COMMUNICATION PERMISSION
Please TICK below to ensure that we have your permission to contact you and to store your data. This will be done in accordance with the a|CITY CHURCH Privacy Policy which is complaint with the Protection of Personal Information Act (POPI ACT), which can be viewed here:
http://acitychurch.co.za/acity-privacy-policy/
I give a|CITY CHURCH permission to contact me via email, WhatsApp or with a call from the church admin office with regards to my request:
*
Yes
No
Thank you so much for your time! One of our incredible team members will contact you as soon as possible.
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
