Date: _________ School Year:_______

Parents’ Names: _______________________________________________________

Phone: (____)____________ Email (required):____________________________

Mailing Address: ______________________________________________________

Street Address (if different):_____________________________________________

Al. Co. of Residence: _________________ Al. School District: ___________

Please list below the names, date of birth, and grade level of the students to be taught at this address:

Are you a member of the Home School Legal Defense

If so, member number: ________________ Renewal Date: __________

Enclose $30 per family per year for registration.

Include $35 orientation fee for families enrolling for the first time.