Part-time/Auditing Student Form

Name

Current Address (please include city, state, and zip code)

(include city, state, and zip code)

Phone Number

Email Address

Where do you attend worship?

Have you been baptized to be added to the Lord's church?

Yes

Are you over 18?

Yes

Name of Parent/Guardian if under the age of 18 (optional)

Current Address of Parent/Legal Guardian (please include city, state, and zip code) (optional)

(include city, state, and zip code)

Support