IBC Home Educators

On-Line Registration Form for 2007—2008:

Enter the following:

Parent Information:

Title:	Mr./Mrs. Mr. Mrs. Ms.
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Telephone Number:	(use this format: 703-555-1212)

E-Mail Address:
Church you attend:

Children:

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Child Name:
Birth date: (mm-dd-yyyy)
Curriculum Used

Areas of Service:

Our group is a co-op and for it to be successful everyone must help in some way! Please prayerfully consider how you will serve within the group. Click here to see the list of service opportunities and choose a place to serve. If you have questions or need guidance, please contact Cheryl Cantanio at cherylcan@verizon.net, 703.536.0476, or Kathy Tozier at rktozier@verizon.net, 703.691.8027. No registration form will be processed without this information.

1st Service Choice:

2nd Service Choice:

Statement of Faith: By checking the "I Agree" box below, you are saying you have read the above statement of faith and believe it to be true. Click here to view the Statement of Faith (pdf).

I Agree

After all information has been entered, please click the Continue button.

If you would like to erase everything and start over, click here: