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Extended Family Group application form

A sample application form for a large or mid-sized church.

Extended Family groups an intergenerational program
2004 UUCB Extended Family Group form
for the Unitarian Universalist Church of Berkeley

An Extended Family Group is an intergenerational group of people who commit themselves to sharing a meal once a month for a year. The goal is to open up new contacts with people of all ages at UUCB simply by sitting down together for a meal, and socializing informally.

Extended Family Groups will consist of 12 to 20 people. Ministers and lay leaders will assign people to an Extended Family Group based on this form. All meals will be "potluck," that is, each person will bring food to share with the rest of the Group. You are asked to make a formal commitment to attend Extended Family Group meetings monthly for a year.

Preferred meeting times: Please tell us which meeting time is best. Mark your best time with a "1," second best with a "2," and third best with a "3." If there's a meeting time you cannot make, please mark it with an "X."
_____ Sunday afternoon (lunch after church)
_____ Sunday evening (dinner)
_____ Friday evening (dinner)
_____ Other time:

About you: Please check any that apply to you:
_____ Can you host 12 to 20 people in your home for a meal?
_____ If so, is your home accessible to wheelchairs?
_____ Are you good at helping to organize people?
_____ Do you have any special needs? any special preferences? If so, please list:

(I) (We) wish to join an Extended Family Group at UUCB....
(I commit myself) (We commit ourselves) to meet with the Extended Family Group once a month, sharing a meal and socializing, for at least one full year (twelve months).

1. Please sign and print name: _______________________________________________________

2. Please sign and print name: _______________________________________________________

Please have any other family members who wish to participate sign this form on the back (children and youth, too), and print their names under their signatures.

Mailing address: _______________________________________________________

City and ZIP: _______________________________________________________

Telephone: _______________________________________________________

Email address: _______________________________________________________

Deadline: Please get this form to Rev. Dan Harper's mailbox in the church office by 3/1/04.