Living Waters Homeschool Registration
*A $40.00 non-refundable Registration fee must be submitted with this application per student. Please make payment
in form of check payable to Cheri O’Steen or on PayPal at PayPal.Me/livingwateragroup using friends and family.
#1 Student Name *
Your answer
#1 Student Classes Enrolling - check all that apply *
Required
#2 Student Name - leave blank if not needed.
Your answer
#2 Student Classes Enrolling - check all that apply. Leave blank if not needed.
Parent Name *
Your answer
Parent Home Address *
Your answer
Parent City/State *
Your answer
Parent Zip *
Your answer
Parent Email Address: *
Your answer
Parent Cell Phone Number *
Your answer
Parent Home Phone Number (not required):
Your answer
Child Allergy or other Medical Concerns:
Your answer
Emergency Contact Information
This is your emergency contact:
Emergency Contact Name: *
Your answer
Emergency Contact Phone Number: *
Your answer
Emergency Contact Relationship: *
Your answer
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