Membership Application Parent Information Have you read and agree with The Rock Homeschool Ministry policies? Yes No Have you read and agree with The Rock Church Statement of Faith? Yes No Mother's Name First Name Last Name Father's Name First Name Last Name Please select a primary contact. * Mother Father Primary Contact Email * Primary Contact Phone * (###) ### #### Other Emergency Contact Name and Phone Number * Primary Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Church Home * If The Rock Church is your Home Church, have you attended Growth Track? * Yes No Do you agree to pay the membership fees in a timely manner? * See policies for details. Yes I would like to talk to a leader about scholarship opportunities. The Rock Homeschool Ministry may use images of my child(ren) in print, web or other forms of publicity. * Yes No Child Information Please include information for all of your children, even if they are not of school age. Child 1 First Name Last Name Allergies? Yes If yes, please specify what the child is allergic to. Current Grade Level Child 2 First Name Last Name Allergies? Yes If yes, please specify what the child is allergic to. Current Grade Level Child 3 First Name Last Name Allergies? Yes If yes, please specify what the child is allergic to. Current Grade Level Child 4 First Name Last Name Allergies? Yes If yes, please specify what the child is allergic to. Current Grade Level Child 5 First Name Last Name Allergies Yes If yes, please specify what the child is allergic to. Current Grade Level Additional Information If you have more than 5 children, please add their information below. Thank you!
