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2024-2025 Leesburg Homeschool Co-op Registration
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* Indicates required question
Father's First and Last Name
Your answer
Mother's First and Last Name
Your answer
Email
*
Your answer
Secondary Email (optional)
Your answer
Phone Number
*
Please state if mother's or father's
Your answer
Secondary Phone Number (optional)
Please state if mother's or father's
Your answer
Mailing Address
*
Your answer
Do you prefer Tuesday or Wednesday?
*
Tuesday
Wednesday
Either
Name of the person bringing your child or children?
*
Your answer
Relationship to Child/Children
*
Your answer
I understand I will be required to stay on Leesburg Campus with children K-8th grade and will help out where needed
*
I understand
I understand there is a required non-refundable registration/supply fee of $20 per child.
*
I understand
Will you be bringing non-school age children with you? If yes, please list the names and ages below.
Your answer
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