Membership Application

Name & Spouse

Complete Address

Home Phone

Work Phone

Cell Phone

E-mail

Children's Names and Birthdays

In case of emergency, call:

Relationship

Home Phone

Work Phone

Cell Phone

Church Home / Affiliation

I am homeschooling at least one child and/or intend to homeschool my preschool children.
I have read and agree with the Statement of Faith and I have accepted Christ as my personal savior.
I have read and my family and I will abide by the Code of Conduct.
I have read and agree to the Release of Liability.