Religious Demographic Survey

1. Location

Dieppe
Moncton
Riverview
Other

2. How long have you lived in this area?   

3. How many people are in your household?    Adults Children

4. Do you currently have a church affiliation?   Yes No

            Church Name  

5. How often would you say you attend?

Regularily
As often as possible
Special occasions (Christmas, Easter, ...)
Very Rarely

6. Do you believe the church has any relevance for today?   Yes No

7. Did you attend church as a child?   Yes No

        If you did, but don't anymore, what made you stop?

8. Do you think it's important for children to have exposure to religion when
    they are young?   Yes No

    Do you think that the denomination is important?   Yes No

9. Would you be interested in learning more about the person of Jesus Christ
    and the joy and purpose that he can bring to your life?   Yes No

10. May we contact you at a latter date regarding some of the questions on this
    demographic survey?   Yes No

11. Would you be interested in receiving a small gift as our way of saying thank
    you for taking the time to fill in this survey?   Yes No

12. Is there any more information you would like to provide us that you think
    would be helpful in our assessment of this survey?

Please provide the following contact information if you said "Yes" to us
    contacting you or to receiving a free gift:

First Name
Last Name
Street Address
Address (cont.)
City
Province
Postal Code
Telephone
E-mail