CHEMPA New Member Registration Form
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Family's Last Name *
Father's Name
Mother's Name
Street Address *
City *
State *
Zip Code *
Phone Number *
Email *
Curriculum/Curricula (optional/this information will be in the directory)
Place of Worship (optional/ this information will be in the directory)
To keep our families safe, we need to verify your identity. Is there someone in the group who you can use as a reference? If so, list their name(s). If not, that's ok, we'd love to meet you! *
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Questo modulo è stato creato all'interno di CHEMPA - Christian Home Educators in the Mt. Pleasant Area. Segnala abuso