Check In Here After the Storm | Countryside Baptist Church of Dover, Inc.

In an effort to make sure we know how all of our members are post storm, we would like you to fill out this simple card so that we can ensure we are directing people and resources to our families in need.

Name (Required)

Email Address (Required)

Address (Required)

Please provide your complete physical address

Please indicate which status best describes you and/or your family's status. (Required)

Pick which option best applies to your family's situation.

Please explain your answer to the previous question in detail. (Required)

If injured, please advise where you or your family member will be. (Home, Name of Hospital, etc.). Please describe damage to Home/Property.

Would you like a Church Representative to reach out to you? (Required)

Would you like assistance with the damage to your Home/Property when and where possible? (Required)

Your Phone Number (Required)

Solve 9 + 1 = ?

Countryside Baptist Church of Dover, Inc.

13422 Sydney Rd
Dover, FL 33527

(813) 571-8200

office@cbcdover.org

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