Applicant’s Statement

The information contained in this application is correct to the best of my knowledge. I authorize any references or
churches listed in this application to give Glory Alliance Christian Home Educators Homeschool Group any
information that they may have regarding my character and fitness in my ability to work with children/youth. In
consideration of the receipt and evaluation of this application by the GACHE Board of Directors, I hereby release
any individual, church, youth organization, charity, employer, reference or any other person or organization, including
record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature
which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this
authorization. I waive any right that I may have to inspect the information provided about me by any person or
organization identified by me in this application.

Should my membership application be accepted, I agree to comply with the Bylaws and Policies of
the Glory Alliance Christian Home Educators Homeschool Group and to refrain from unscriptural
conduct in the performance of my services on behalf of said Homeschool Group.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE
CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding
agreement, which I have read and understand.

Please Type your FULL name and Date to legally agree.

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