Parents' Names:____________________________________________
Address:__________________________________________________
_________________________________________________________
Home Phone: ________________________
Work Phone: ________________________
E-Mail: ____________________________
Fax: ______________________________
Church Attending: ________________________________________________
Mom's Birthday: ___________
Child's Name Birth Date Entering Grade___________________________________________
_______________________________________________
_______________________________________________
How long have you home schooled? _________________________________________________
What curriculums have you used? _________________________________________________
What is your greatest area of need in regard to home schooling? __________________________________________________________
How would you be willing to serve the group?
__________________________________________________________
__________________________________________________________
If you would like your business or service to be included in the group
directory for referral or networking, please submit a business card, or relevant
information along with this form.
Place of employment: _________________________________
Occupation:_________________________________________