To Registered fill in the form below and Submit it or Print it and Mail or Fax  it to the Church.

TODAY'S DATE

STUDENT'S NAME  

HOME PHONE      PARENT'S BUSINESS PHONE

CELL PHONE       E-MAIL

STUDENT'S ADDRESS  

CITY       STATE     ZIP CODE 

RESPONSIBLE PARTY'S NAME    

RESPONSIBLE PARTY'S PHONE #   BUSINESS PHONE #

RESPONSIBLE PARTY'S BILLING ADDRESS  

CITY     STATE     ZIP CODE

STUDENT'S BIRTH DATE          STUDENT'S AGE   

WHAT LESSON/CLASS ARE YOU REGISTERING FOR?  

HAVE YOU STUDIED FOR THE ABOVE LESSON/CLASS BEFORE?    YES    NO       HOW LONG?  

HOW DID YOU FIND OUT ABOUT US?   

(FOR STUDENT'S 18 YEARS AND UNDER)

SCHOOL  

FATHER'S NAME  

MOTHER'S NAME

CHURCH NAME  

CHURCH ADDRESS