Membership information(FORM 1)

 

G*L*O*W Johnstown Homeschool Group Membership Application(FORM 1)

Last Name:_______________________________________________________

Father's first name:_________________________________________________

Mother's first name:________________________________________________

Address:________________________________________________________

City: ____________________________________      State: PA ZIP: __ __ __ __ __

County: ____________________________

Primary E-mail:_________________________________________________

Secondary E-mail:_______________________________________________

Phone 1: __ __ __ - __ __ __ - __ __ __ __

Phone 2:__ __ __ - __ __ __ - __ __ __ __

HSLDA Member: Yes / No                 School District: _______________________

Please list the name, age, and grade level of each child in your family.

(Including students that may not be homeschooled)

Name                                                                        Age Grade Level

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

I have read and understand G*L*O*W Johnstown Homeschool Groups Vision
 and Statement of Faith and I understand the Christian identity of Charity 
Homeschool Group. I agree that I and my family will abide by the Christian principles 
that are practiced by Charity Homeschool Group during all group events and activities.

________________________________    _________________________________

Father’s Signature                     Date Mother’s Signature                 Date