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2022/23 BHC Interest Form
Please fill out this form if you are interested in Blaine HomeConnection for the 2022/23 school year. If you have more then one student, please submit one form per student.
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Email
*
Your email
Parent Name (First, Last)
*
Your answer
Phone Number
*
Your answer
Student Name (First, Last)
*
Your answer
Student Grade for Fall 2022
*
Your answer
What school district do you currently reside in?
*
Your answer
Have you ever homeschooled before?
*
Yes
No
What extra supports does your student need, to be successful in school?
*
Your answer
Do you or your current school have any concerns with your student in the following areas?
*
Attendance
Discipline
Academic Performance
None of the Above (No Concerns at this time)
What brings you to Blaine HomeConnection?
*
Your answer
Send me a copy of my responses.
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