Registration

Fields marked with a * are required.

Enrollment Guidelines

Enrollment is open to families with at least one attending child who will be between the ages of 4 – 18 (as of September 1st) in any given session. Junior sibling members (nursery ages 6 months – 3 years) are accepted based on availability, if the above requirement is met. Priority is given to currently attending families, followed by families on the wait list, with open enrollment starting thereafter.

Cost

14 Week Session Full Membership (2-14 Year Olds)

– $175 1st Child

– $145 2nd Child

– $130 Each Additional Child

– $35 Junior Sibling Membership (Nursery Only, 6-23 months)

– 15-18 Year Olds – Program starting soon, please Contact Us!

Attending Parent/Guardian Contact Information

First Name of Attending Parent/Guardian *

Last Name of Attending Parent/Guardian *

Email of Attending Parent/Guardian *

Phone for Attending Parent/Guardian *

Non-Attending Parent/Guardian Contact Information

First Name of Non-Attending Parent/Guardian

Last Name of Non-Attending Parent/Guardian

Email of Non-Attending Parent/Guardian

Phone for Non-Attending Parent/Guardian

Family Mailing Address

Address *

City *

Zip / Post Code *

Attending Children

Please refer to the Membership Payment Chart for assistance in completing this section, and kindly list ALL of your children you will be bringing to The Community Co-op.

Child 1 - First Name *

Child 1 - Last Name *

Child 1 - Age (as of Sep 1) *

Child 1 - Date of Birth *

Child 2 - First Name

Child 2 - Last Name

Child 2 - Age (as of Sep 1)

Child 2 - Date of Birth

Child 3 - First Name

Child 3 - Last Name

Child 3 - Age (as of Sep 1)

Child 3 - Date of Birth

Child 4 - First Name

Child 4 - Last Name

Child 4 - Age (as of Sep 1)

Child 4 - Date of Birth

Child 5 - First Name

Child 5 - Last Name

Child 5 - Age (as of Sep 1)

Child 5 - Date of Birth

Child 6 - First Name

Child 6 - Last Name

Child 6 - Age (as of Sep 1)

Child 6 - Date of Birth

Payment Totals

Credit for Deposit Help Text

Sub Total

Total

Membership Agreements

I/We, the undersigned, have read and agree to, the foregoing Member Agreements, Policies and Procedures outlined in the the most current Co-op Handbook available at nearwesthomeschoolers.org, and agree to abide by the agreements, policies, practices outlined within it. In the event of illness or accident, I/We request that measures be instituted without delay, in accordance with the Emergency Medical Form(s) provided, as judgment of medical personnel dictates. Our digital signature(s) contained herein shall be legally binding equivalents to a handwritten signature. Lastly, I/We further agree to have fun and smile as frequently as possible, to the extent I/We are able. After all, that is what homeschooling is all about. * Help Text

Attending Parent/Guardian Signature *

Non-Attending Parent/Guardian Signature

Child 1 - Signature *

Child 2 - Signature

Child 3 - Signature

Child 4 - Signature

Child 5 - Signature

Child 6 - Signature

Date *

Please enter the Co-op password here. * Help Text