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Application to Join CHASE

* indicates a required answer.

If you would like to apply for membership in CHASE for the 2019-2020 school year, please complete and submit the form below.

1. *

Father's First & Last Name:

2. *

Mother's First & Last Name:

3. *

Street Address:

4. *

City, State:

5. *

Zip Code:

6. *

Primary Phone:

7.

Cell phone:

8. *

E-mail:

9. *

Father's Occupation:

10. *

Mother's Occupation:

11. *

How did you hear about CHASE?

12.

Did you read our Statement of Faith?

Yes No
13.

Do you agree with our Statement of Faith?

Yes No
14.

Do you regularly attend church?

Yes No
Sometimes
15. *

Please tell us the name of your home church and how your family is involved in the church:

16. *

How long have you homeschooled and why do you choose to homeschool?

17. *

Have you been involved with another co-op?  If you have, please tell us which one(s) and your reasons for leaving.

18. *

List skills you may share with CHASE, any subjects in which you have interest or experience, and/or any classes you have taught in the past:

Children (Please include all children, even if the grade is blank.)

19. *

Child 1 Name:

20. *

Child 1 date of birth:

21. *

Child 1 Grade for the 2019-20 School Year:

22.

Child 2 Name:

23.

Child 2 date of birth:

24.

Child 2 Grade for the 2019-20 School Year:

25.

Child 3 Name:

26.

Child 3 date of birth:

27.

Child 3 Grade for the 2019-20 School Year:

28.

Child 4 Name:

29.

Child 4 date of birth:

30.

Child 4 Grade for the 2019-20 School Year:

31.

Child 5 Name:

32.

Child 5 date of birth:

33.

Child 5 Grade for the 2019-20 School Year:

34.

Child 6 Name:

35.

Child 6 date of birth:

36.

Child 6 Grade for the 2019-20 School Year:

37.

Child 7 Name:

38.

Child 7 date of birth:

39.

Child 7 Grade for the 2019-20 School Year:

40.

Child 8 Name:

41.

Child 8 date of birth:

42.

Child 8 Grade for the 2019-20 School Year: