2004/2005 MEMBERSHIP APPLICATION
LAST NAME_______________________FIRST___________________SPOUSE___________________
ADDRESS____________________________________________________________________________
CITY_________________________ZIP________________E-MAIL______________________________
HOME PHONE_________________CELL__________________EMERGENCY____________________
Children’s Names Birthday Age Home school or Public school
________________________ ____________ __________ ___________________________
________________________ ____________ __________ ___________________________
________________________ ____________ __________ ___________________________
________________________ ____________ __________ ___________________________
________________________ ____________ __________ ___________________________
________________________ ____________ __________ ___________________________
SURVEY (OPTIONAL):
How many years have you home schooled?________ or check here if this is your first year____________
What curriculum does your family primarily use?_____________________________________________
Do you use an umbrella school, video, or satellite programs?_______ Which one?___________________
Does your family have a home church?_________ Which one?__________________________________
What types of business or occupation are represented in your home?______________________________
What are your hobbies, gifts, or talents?_____________________________________________________
If a need arises would you be willing for us to approach you regarding a use for those talents?__________
Do you have any information to share with the group regarding upcoming co-ops, classes, or events as we prepare the year’s schedule?______________________________________________________________
_____________________________________________________________________________________
FEES:
CHF yearly membership fees are $20 per family if you receive your newsletter/E-mail updated on-line. Please add $5 if you wish to receive a copy of the newsletter/E-mail updates in the mail.
CHF Membership (just $15 if received prior to 8/15) $20.00 _________________
Optional Newsletter mailing & copy fee $ 5.00 _________________
FPEA Membership (Prior Member #______________ to renew) $15.00 _________________
Total Fees Due _________________
Please make your check payable to CHRISTIAN HOMESCHOOL FELLOWSHIP and return the application, medical release/Release of Liability forms, PE Application, and Secret Sister request to CHF at the address below.
I have read and understand the CHF Statement of Faith and am actively educating my child(ren) with legitimate educational goals and a determined course of action to meet those goals. I understand that my personal information will not be sold or shared with any entity and is for the sole purpose of networking with CHF members. I understand that I may not use the Member Roster I receive as an advertising tool for any business of any type or use CHF activities to promote my business.
Parent/Guardian Signature________________________________ Dated:______________________
Parent/Guardian Signature________________________________ Dated:______________________
13587 76th Rd. North, West Palm Beach, FL 33412
Website: www.angelfire.com/fl2/proverbs22six/CHF.html
P.E. Registration
The P.E. program offered by Christian Homeschool Fellowship (CHF) is volunteer
based. There is no fee. The requirements are as follows:
All children must be at least five years old to participate. This is not a drop
off program. You are expected to stay the entire time. If you are unable to be
present but wish to have your child participate in the activities it will be
your responsibility to find another parent to supervise your child. The coaches
cannot be asked to supervise your child in your absence. You are fully
responsible for your child at all times.
Parent's Name:___________________________________________
Telephone number: Home:________________ Cell:_______________
In case of an emergency contact: ______________________________
Child's name: Age Birthday:
____________________ ______________ ____________________
____________________ ______________ ____________________
____________________ ______________ ____________________
____________________ ______________ ____________________
____________________ ______________ ____________________
____________________ ______________ ____________________
* IT IS IMPORTANT THAT YOUR CHILD HAVE A DRINK AT EVERY P.E. DAY.
By signing this form I acknowledge that I take full responsibility for my child
during the P.E. time. I will not hold CHF or any of it's members responsible
for any injury that happens while my child is participating in any of the
activities.
__________________________________ Date: ______________
