Haven Homeschoolers Membership Profile
Last Name:_______________________________
Father’s First Name:_______________________________
Mother’s First Name:_______________________________
Street Address:_____________________________________________________________
City:____________________________
State:______________ Zip:________________
Home Phone:_____________________________
E-mail:________________________
| Please list your children with their ages as of Sept. 1 and the grade they would be in if attending school: | ||
| Childs Name | Age | Grade |
Curriculum(s) you use:____________________________________________
Home business you'd like to advertise to Haven Homeschoolers members:_________________________
Volunteer Position you'd like to fill: ___________________________________________________________
As the parent or legal guardian of the child(ren) listed on this Membership Profile, I consent and agree that said child(ren) may participate in group activities and events. I hereby assume all risk as a result of my child(ren)'s participation in the events and activities. I also hold harmless and indemnify Haven Homeschoolers, its leadership, and any volunteers for accidents, injury, illness, or any other condition which may jeopardize the health/safety of my child(ren) involved therein. I have read and agree to uphold the organization, policies and Christian convictions while participating in group activities.
| _________________________
Parent/Guardian's Printed Name |
_________________________
Parent/Guardian's Signature |
________________
Date |
Please complete this form and submit with your membership dues to Cheree Brennan. Cheree may be reached at havenhomeschoolers@yahoo.com. (Make checks payable to Haven Homeschoolers).
Office Use Only:
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