H.E.A.R.T.
HOME EDUCATED AND RIGHTEOUSLY TRAINED
MEMBERSHIP FORM
DUES $10.00
PARENTS NAME::
ADDRESS:
BEST TIME TO REACH YOU:
PHONE NUMBER:
E-MAIL ADDRESS:
DO YOU HAVE INTERNET?
CHILDREN-NAME, AGE, AND DATE OF BIRTH
HOW LONG HAVE YOU BEEN HOMESCHOOLING?
CURRICULUM USED
ANY SUBJECT AREAS THAT YOU FEEL YOU NEED ASSISTANCE IN?(BIOLOGY, PHYSICS, CHEMISTRY, ALGEBRA,
HOME EC.,ETC.)
PLEASE LISTS SKILLS &/OR DEGREES THAT YOU MAY HAVE: ex: Academic Subjects, Vocational or any type of
Home Ec Skills, CPR, First Aid, Sign Language, Etc.
WHAT WOULD YOU LIKE TO SEE DIFFERENT THIS YEAR?(FIELD TRIPS, 4-H, ACTIVITIES, MEETINGS, YEARBOOK,
ETC.)
WHICH OF THE FOLLOWING COMMITTEES WILL YOU BE HELPING WITH THIS YEAR?
MOM'S NIGHT OUT
FIELD TRIP PLANNING
ACTIVITY PLANNING
EXTRA CURRICULAR ACTIVITIES
STATE LIAISON/TESTING
NEW MEMBERS
ENRICHMENT CLASSES
PHONE TREE
OTHER
MAIL APPLICATION AND $10.00 DUES TO:
TINA GEORGE
1305 N. MOSBY
EL DORADO, AR 71730
