WSCI Check-In

Hi World Shaker! WE MISS YOU! Please take a second to complete the form below and let us know how you’re doing. ♥️

Love Always,

-Pastor J. & Lady P.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is everything well?

Is everything well with your family?

Are you in a healthy and safe environment?

Are you able to sustain food? If no, how soon do you need groceries?

May we contact you? We would love to hear from you.

Are there any concerns you would like us to be aware of?