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 NameLast 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 CodePhone 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