Parent Consent Form

"THE ABSTINENCE CLUB"
a Ministry of HOUSE of GOD INTERNATIONAL OUTREACH MINISTRY

Pledge Form
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                                                           Parent Consent Form

I (we) hereby grant permission for my (our) child                                                                          participate in and
become a member of T.A.C. (The Abstinence Club) at House of God International Outreach Ministry.

I (we) understand that this is not a counseling group but a club where (children, teens, young adults) come together
and agree to abstain from any harmful substance and activity. Literature will be given and there will be professional
speakers from time to time to teach on various subjects.

I (we) understand that my child is an online member and that their membership card, bracelet, and any literature will be
mailed to our home by The Abstinence Club at House of God International Outreach Ministry. I (we) also understand
that this form along with the pledge form for my child(ren) must be printed and mailed to the appropriate address.

Child's Name:                                                                              Age:

Address:

City:                                                                            State:                                            Zip Code:

Grade:                                                                             Date of Birth:

Signature of Parent/Guardian:

                                                E-Mail

                                                                        Or Mail To:
                                             House of God International Outreach Ministry
                                                             Attn: The Abstinence Club
                                                              1301 Seminole Blvd, #137
                                                                      Largo, Fl 33770

T.A.C. ~ The Abstinence
Club