HOJC Account Form

Please fill in the following Personal information for our records:

Name:               

Address:            

City, State, Zip:  

Phone:                

Please choose a Screen Name.  Although you may use your first name, we suggest that you choose a nickname so that personal information about you is reduced.

Screen Name:

E-mail (Check one)

I do not want an E-mail account

Please Set up an E-mail Account for me 

Please forward all my mail to

Personal Web Page (Check one)

I do not want a Personal Web Page

Please Set up Personal Web Page Account for me 

Please make a page that has hits that will be forward to

Internet Browser Privileges (Check one)

I do not want Internet Browser Privileges using church computers

Please Set up an Internet Browser Privileges

Signature Section

Account User Signature: I agree to follow all HOJC account rules and understand that my account(s) may be terminated.  I agree that if I stop attending HOJC, that I will notify the HOJC web staff immediately.

______________________________  Date: _____________

Class Recommendation Signature (for account user under 18):  I recommend this User for a HOJC account.

______________________________  Date: _____________

Parents Signature (for all account users under 14):  I agree that my son/daughter may have this account.  I understand that some personal information may be revealed by this account.

______________________________  Date: _____________