Prospective Member Form

Once your Prospective Member Form has been submitted, we will contact you to schedule an interview. We look forward to meeting you!

*Mother Name

Father Name

Mother Occupation/Degree Father Occupation/Degree

*Address *City *Zip

*Phone

Cell

*Email Address

*Emergency Contact Name *Number

Number of Years Home Schooled

Where did your children attend school prior to home schooling?

Have you been a member of a homeschool group before?
Name of Group Group Contact Name
Name of Group Group Contact Name

*Family Attends Church at Member: Yes No

*Child's Name	*Birth Date (xx/xx/xxxx)	*Grade	*Male / Female
			M F
			M F
			M F
			M F
			M F
			M F

*Do you and your spouse have a growing relationship with the Lord?

*Briefly explain.

CHFM is a cooperative effort and parents are frequently responsible for assisting the instructors in a class setting. What strengths will you bring to CHFM?

Do you have any special areas of expertise?

Any outstanding strengths or weaknesses in your children?

CHFM is a structured and intense program that requires a high degree of work and commitment. What would you like or not like about CHFM ?

*Do you foresee any problems fulfilling your commitment?

*Why do you desire to be a part of CHFM?

*Required

I understand and agree to the following:

I understand that to become a new member for the Spring 2012 session I must attend a MANDATORY informational meeting on Wednesday, January 18, 2012, at 2:00 p.m.

This prospective member form must be submitted by Tuesday, December 13, 2011.