Membership Registration 2018-2019

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Student Name *

Mailing Address *

Student Date-of-Birth *

YYYY

Student Grade this Fall *

Parent Name *

Email Address *

Cell Phone *

Student is interested in the following: *

Field Trips

Musical Theater

Service Scouts

Homeschool Ballet Theater

Homeschool Bowling League

Homeschool Track

Graduation Ceremony

Required

I have read and agree to abide by the Governing Values, Membership Policy and Procedures. *

Yes

In the event of an accident or injury, I will assume full responsibility for my child, thereby releasing Texas HOME Educators, Mid-Way Baptist Church, Studio D, its representatives, teachers, volunteers and members of any obligation or responsibility. *

Yes

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