Parent Enriched Academy of Cooperative Education (PEACE) Application Form

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Parent Enriched Academy of Cooperative Education (PEACE) Application Form - Fall Semester 2019

This is the application for the Fall Semester from March 13 through June 5, 2019 taking place at the Unitarian Universalist Congregation of Columbus at 7850 W Goeller Blvd, Columbus, IN 47201. Registration deadline for this semester is Augut 21st, 2019. Please fill out and submit this application as soon as possible to help teachers prepare for this semesters classes.

Email *

Parent Information

Parent (or Guardian) Name *

Phone Number *

Address *

Emergency Contact Name (of someone who won't be present at the co-op in case the parent is sick or injured) *

Emergency Contact Phone Number *

Any Allergies, Illnesses, or Specific Needs that you would like for our volunteer staff to know about: *

Child Enrollment Information

Name and Age of First Child *

Age Group *

0-1 Years

2-3 years

4-5 Years

6-8 Years

9-11 Years

12-14 Years

15-18 Years

Name and Age of Second Child

Age Group

0-1 Years

2-3 years

4-5 Years

6-8 Years

9-11 Years

12-14 Years

15-18 Years

Clear selection

Name and Age of Third Child

Age Group

0-1 Years

2-3 years

4-5 Years

6-8 Years

9-11 Years

12-14 Years

15-18 Years

Clear selection

Name and Age of Fourth Child

Age Group

0-1 Years

2-3 years

4-5 Years

6-8 Years

9-11 Years

12-14 Years

15-18 Years

Clear selection

Parent Volunteers

We currently have a large number of kids, which is wonderful, but will require a lot of hands-on help. At the moment, it will take the efforts of all parents to keep the co-op running smoothly. Please check any boxes that you are interested in helping out with, great or small, to help give our kids an awesome experience.