Ecclesia Prep - Request Family Membership with Ecclesia Prep!

First Name

Last Name

Birthdate

Grade

Student Email/Username

Student Password

If Student Username and Password are both provided, child will have the ability to login.

Child Phone (Optional)

Enable Text Messages

Child is able and agrees to receive text messages at this number.
We understand carrier message and data rates may apply.

Medical Notes/Allergies? Yes No

Upload Child Photo (Optional) .jpg, .gif or .png

*	T-shirt size

*	Student Grade Level

Many Emails: Would you like to receive notifications IMMEDIATELY? Yes No

Delivery Type Whole Thread New Part Only

Daily Digest: Would you like to receive notifications ONCE A DAY? Yes No

Request Family Membership with Ecclesia Prep!