Parent(s) Name: ____________________________________________ Spouse’s Name:______________________ Address: ______________________________________________________________________________________ City:____________________________________________ State: ___________ Zip: __________________ Home Phone: ______________________________________ Cell Phone: __________________________________ E-mail: ________________________________________________________________________________________ YES NO I wish to join the FPEA for $20.00. If already a member, please give FPEA ID# _______________________________ . Household Registration fee is $20.00 per family. Children Information Child 1 Name: ___________________________________________ Nickname: _____________________________ D.O.B.: _______________________ Age: ______________ M/F: ______ Grade: _____________________ Child 2 Name: ___________________________________________ Nickname: _____________________________ D.O.B.: _______________________ Age: ______________ M/F: ______ Grade:_____________________ Child 3 Name: ___________________________________________ Nickname: _____________________________ D.O.B.: _______________________ Age: ______________ M/F: ______ Grade:______________________ Child 4 Name: ___________________________________________ Nickname: _____________________________ D.O.B.: _______________________ Age: ______________ M/F: ______ Grade:______________________ Child 5 Name: ___________________________________________ Nickname: _____________________________ D.O.B.: _______________________ Age: ______________ M/F: ______ Grade:______________________ |
| HOMESCHOOL-BLESSINGS "Capturing Life's Blessings Through Home Schooling" 2011-2012 REGISTRATION FORM |