Declaration OF Faith BY A Parishoner

of Black Rose Spiritual Center

Black Rose Spiritual Center

I, __________________________________, being of at least 18 years of age, or with the signed
permission below of my parent or legal guardian if under the age of 18, do hereby formally state my wish
to become a member of the Church known as the Black Rose Spiritual Center. By this declaration of
faith I swear to uphold the mission statement of the Center and to conduct myself in accordance with
the rules and guidelines of the Church and it’s liturgical hierarchy.

I do so swear this ______ day of _________________________, 20____.


(If the above is under the age of 18.)

I, _____________________________________________, parent or legal guardian of the minor
child _____________________________________________ listed above do by my signature
below grant approval for my minor child to participate in the religious services and activities of the
Black Rose Spiritual Center.

Dated this ____ day of ____________________, 200________

Membership Fee of $20.00 Paid? YES NO

If Yes: payment type:
Date Received:
Receipt Number:

If No: Please give a brief explanation why not. Members of Black Rose Spiritual Center have authority to waive the one time membership fee for reasons stated in the governing documents.