Virtual Course Registration Form

Road to Purity

Welcome! Please complete the form below to register your child for the Road to Purity course. This program is designed to equip youth with biblical principles, healthy boundaries, and a strong sense of identity in Christ. We look forward to walking this journey with you and your child!
Please Read Before Continuing!!!! Thank you for your interest in the Road to Purity course with D.I.V.E. Ministries. This is an 8-week, faith-based program held every Monday from 7:00 PM to 8:30 PM via Zoom. The total cost is $100, which includes all sessions, a certificate of completion, a purity ring, and a closing ceremony. Sponsorships are available upon approval. Please note that sensitive topics such as sex and relationships may be discussed in a respectful and age-appropriate way, grounded in biblical values. By continuing, you confirm that you understand the course details, agree to the program fee (or plan to apply for sponsorship), and consent to your child participating in all course discussions. Do you agree to these terms and wish to continue with registration?
Parent/Guardian Information
First NameLast Name
Phone Number
Email Address
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Mailing Adress

Street Address

Street Address Line 2

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Postal / Zip Code
Student Information
Student Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Grade Level
T- Shirt size
Ring Size
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Please upload your child's recent photo

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Does the student have any disabilities, illness, medical conditions, personal problems, etc. that can affect her virtual classes/study?
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How did you learn about this virtual course?

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Student Signature
Date Signed

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Date
Parent/Guardian Signature
Date Signed

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Date
Will you be submitting your course payment online or in person?(Paypal payment only)
Virtual Course Registration Form

Donations are welcome via www.diveministry.org
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Purity Course
This payment covers full enrollment in the Road to Purity 8-week course offered by D.I.V.E. Ministries. The total includes access to all sessions, course materials, a certificate of completion, a purity ring, and participation in the final ceremony.

$100.00 Quantity

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Road to Purity

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Virtual Course Registration Form

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