CCF Home School Registration Request

Name of Parent(s)/Guardian

First Last
First Last

Name of Child/Children:

First Last Grade:
First Last Grade:
First Last Grade:
First Last Grade:
First Last Grade:
First Last Grade:

Church We Attend

Pastor & Pastor's Email

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Your Contact Information

Home Phone
Work Phone

Matters of Faith

I have read and agree with the CCF Statment of Faith
I and my children are active members of a church or are looking for a church home
When you have completed this form please print the form and mail it to:
Pastor Mathew "Duke" Clements
830 Birch Trail
Crownsville MD 21032
Thank You