RHE Membership 2019-20
Last Name: *
Your answer
First Name: *
Your answer
Primary Phone Number (include area code) ("Primary" means number you prefer to be called on like home or cell number) *
Your answer
Secondary Phone Number (include area code) ("Secondary" means another number you might be contacted on like cell phone number.) *
Your answer
E-mail Address *
gmail.com emails only, please.
Your answer
Spouse Name (include first and last name)
Your answer
Spouse Primary Phone Number (include area code)
Your answer
Spouse E-mail Address - needed only if your spouse would like to receive group information emails and access to the calendar and documents.
Your answer
Home Address: *
Your answer
City: *
Your answer
Zip Code: *
Your answer
Child's Full Name and Birth month/year (mm/yy) *
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Child's Full Name and Birth month/year (mm/yy)
Your answer
Please select an area of service from the list below to organize or assist with. (First year members exempt) *
Required
Do you give permission for Riverbend Home Educators to publish photos of your family members on our website and/or other media outlets? *
If you answered 'no' above, would you still like pictures of your family members taken but only shared privately?
How did you hear about us (or who referred you?) *
Your answer
Do you have any field trip or co-op class suggestions for the upcoming school-year?
Your answer
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