Home School Registration Form

Name

Email

How many adults will be attending? (we charge for adults)

Dates/Times March 19, 2012 1:30-4:00 PM - Promise of a Good Life & Promise of a Settlement May 8, 2012 1:30-4:00 PM - Promise of Government & Promise of Change

Please list any additional comments or special needs such as food allergies here.

Notes/Comments/Special Needs

I want to check my student(s) into the program and will pick them up at the end.

Student will be picked up by someone other than parent.

Name

We will contact you to arrange payment after we have received your submission. Click here for more information on how to make an online payment through PayPal.

Pricing Information:

• Home School Days is $6 per person (adults included).

Payment Options Paypal
Personal Check
*

Home schooled children who are being checked in and not accompanied by an adult need to submit a medical release form.

Please read and check all the below boxes as an indication that you have done so.

I understand a Home School medical release form must be submitted for any student that is being checked in and not accompanied by an adult. *

I understand toddlers and babies in strollers are not allowed during the Promise Program. *