Student Body Card Request Form

STUDENT ENROLLMENT REQUEST

Embassy of Heaven Church

www.EmbassyOfHeaven.Org

Please type or print clearly using black ink:

Student's Full Name

Student's Year of Birth

Height

Weight

Sex

Eye color

Hair color

[ ] Please issue photo ID

[ ] Please issue ID without photo

[ ] Not interested in ID card

Upon acceptance, a plastic Student Body Card will be issued if requested. For photo ID, please send 2 close-up portraits. For best results, photos should be taken against a solid-colored background with head tuned slightly to right.

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Date

Signature inside box will be electronically transmitted onto card.

Parent or Guardian's Name

Address

City, State, ZIP

Area Code Phone Number

     I declare that I am reborn as a citizen of the Kingdom of Heaven. I give my allegiance to Jesus Christ, the Son of God. I will love one another as He commanded. I renounce all allegiance and fidelity to every foreign prince, potentate, state or sovereignty whatsoever and to the world itself.
     I declare that I am competent to teach the children entrusted to my care and will bring them up in the nurture and admonition of the Lord.
     I, the undersigned, am the parent or guardian of the above-named child and desire to enroll my child in the Embassy of Heaven Christian school.

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Date

Office use only

Number:

Original Date:

Issue Date:

Expiration Date:

Mail completed request form, 2 photos and donation to:
Embassy of Heaven Church; PO Box 337; Stayton, Oregon 97383-0337.