Online Registration Form

* indicates a required answer.

1.
*

Parent Name:

2.
*

Parent Attending?

Yes ($30) No
3.
*

Address:

4.
*

City:

5.
*

State:

6.
*

Zip:

7.
*

Phone: 

8.
*

Email:

9.

Student Name, Age:

10.

Student Name, Age:

11.

Student Name, Age:

12.

Student Name, Age:

13.

Student Name, Age:

14.

Student Name, Age:

15.
*

Register in an afternoon class ( 1:00 – 3:30) if the need arises.

Yes No

$30.00 per student

$35.00 per student on or after 10/29/12

Registration is not confirmed until payment is received. 

Make checks payable to: NEPHS

Send To:

NorthEast Portland HomeSchools

PO Box 68135

Oak Grove, OR. 97268

 

Email at: nephs.art@gmail.com