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2023-2024 C.H.E.A.H.A. Membership Application
Personal Information, Membership and Responsibilities Statement, Code of Conduct
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* Indicates required question
Are you a NEW MEMBER or RETURNING MEMBER?
*
Choose
New Member
Returning Member
Will your student be a senior?
*
Choose
Yes
No
Mother's Name (or Guardian's name) (Last, First, MI)
*
Your answer
Father's Name (or Guardian's name) (Last, First, MI)
*
Your answer
Who has legal custody of homeschooling child/children?
*
Your answer
Primary Homeschool Instructor (if not parent or guardian) (Last, First, MI)
Your answer
Child #1 Name, date of birth & grade for this school year
*
Your answer
Child #2 Name, date of birth & grade for this school year
Your answer
Child #3 Name, date of birth & grade for this school year
Your answer
Child #4 Name, date of birth & grade for this school year
Your answer
Child #5 Name, date of birth & grade for this school year
Your answer
Child #6 Name, date of birth & grade for this school year
Your answer
Home Address (Street address)
*
Your answer
City, State, Zip Code
*
Your answer
Please type your primary phone number & specify cell/home/work
*
Your answer
Please give a secondary phone number & specify cell/home/work
*
Your answer
Email Address (please type "no email" if you do not have an email address.) NOTE:
Please list no more than two (2) email addresses for your family. These will be used to join our website as well as receive communication from C.H.E.A.H.A.
*
Your answer
Email Address 2 (please type "no email" if you do not have an email address.) NOTE:
These will be used to join our website as well as receive communication from C.H.E.A.H.A.
Your answer
Would you like to be added to the CHEAHA Facebook Page?
*
Yes
No
1) What is your Facebook username if you want to be added to the group?
To be added to our Facebook page, please list your Facebook username. You may also add the user names of your
immediate family
so that they may join and have access to our Facebook group. Only family members will be granted access to the Facebook group
Your answer
2) Facebook Username
Your answer
3) Facebook Username.
Your answer
4) Facebook Username.
Your answer
NOTE: CHEAHA reserves the right to use photos taken at CHEAHA events and activities in any and all of its publications, including social media, website, newsletters, yearbook, and other printed publications.
*
Agree
Required
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