Individual Registration

Individuals Registration

This form must be completed. You will be redirected to the Abuse Video. After viewing video you will need to take the test. A copy of your test result will be sent to your email inbox. Follow directions as they appear from page to page. Thank you.
Full Name *

First Name Last Name
Address *
City *
State *
Zip Code *
Home Church *
Facility where you will serve, if known
Your Email: *
PREFERED METHOD OF CONTACT *
Leaders name
Home Number *

Area Code Phone Number
After you view the Abuse Video and take the test, if you have not been assigned a position or a home to minister in, please call the Life-Line Office at (619) 596-7667
Should be Empty:

Individuals Registration