Father's First & Last Name:

Mother's First & Last Name:

Street Address:

City, State:

Zip Code:

Primary Phone:

Cell phone:

E-mail:

Father's Occupation:

Mother's Occupation:

How did you hear about CHASE?

Did you read our Statement of Faith?

Do both parents agree with our Statement of Faith?

Are both parents in agreement with educating your children within a Biblical Worldview?

How often do you attend church?

Please tell us the name of your home church and how your family is involved in the church. (A letter of recommendation from a pastor will be required prior to registration.)

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

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

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:

Child 1 Name:

Child 1 date of birth:

Child 1 Grade for the 2024-2025 School Year:

Child 2 Name:

Child 2 date of birth:

Child 2 Grade for the 2024-2025 School Year:

Child 3 Name:

Child 3 date of birth:

Child 3 Grade for the 2024-2025 School Year:

Child 4 Name:

Child 4 date of birth:

Child 4 Grade for the 2024-2025 School Year:

Child 5 Name:

Child 5 date of birth:

Child 5 Grade for the 2024-2025 School Year:

Child 6 Name:

Child 6 date of birth:

Child 6 Grade for the 2024-2025 School Year:

Child 7 Name:

Child 7 date of birth:

Child 7 Grade for the 2024-2025 School Year:

Child 8 Name:

Child 8 date of birth:

Child 8 Grade for the 2024-2025 School Year: