Challenger Homeschool 2016-2017 Registration Form
Name of Child *
[Please fill out one child per form]
Your answer
Name of Parent[s]/Guardian[s] *
Your answer
Which session(s) will your child be attending? *
Required
Phone *
Your answer
Email *
Your answer
Email Confirmation *
Your answer
Address
Your answer
City
Your answer
State and Zip
Your answer
Approx Reading Grade Level
Your answer
Approx Math Grade Level
Your answer
Age of Child
Your answer
Does you child have allergies/ medical condition(s)/ special needs: *
If yes, does the condition require your child to have access to mediciation during the homeschool program? Please explain.
Your answer
Would your child be taking any medication during the homeschool program: *
If yes, please explain further.
Your answer
Does your child have special accomodations during school: *
If yes, please explain further.
Your answer
Have you previously attended one of our Homeschool Sessions?
Any special needs we should aware of
Your answer
How did you hear about our Homeschool Sessions?
Do you want to be part of our email update list?
Additional Commets
Your answer
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