Request Membership

Fill out the form below and click the Continue button at the bottom.

If you have not read through the Registration Instructions posted in the I'm New section of the UHC website, please STOP and do so BEFORE proceeding.  You may be filling out this form during a time that pre-registration is NOT open, and your submission will NOT be valid, and your information will be deleted.


Welcome to the online portion of the NEW MEMBER pre-registration process for Upstate Homeschool Co-op for 2015-2016.

Upstate Homeschool Co-op requires the following pre-registration forms to be filled out prior to approving membership.

* indicates a required field
*Primary Last Name:
*Primary First Name:
*Primary Email:
Secondary Last Name:
Secondary First Name:
Additional Email Address(es):
Separate multiples with a comma.
If additional email address(es) are entered above, should they also receive weekly email and forum notifications, etc.?
Yes     No
*Address:
*City:
*State/Country:
For United States and Canada:
For Other Countries:
State/Province:
Country:
*Zip/Postal Code:
* Timezone:
*Area Code:
*Phone:
Children:
Show Children Info to Other Families:
*User Name: (must be 3-15 characters long)
*Password: (must be 3-15 characters long)
*Confirm Password:
 
*Weekly Email Update: Would you like to receive a weekly email update?
Yes    No
 
*Forum Emails: Would you like to receive forum notifications via email (not just the ones you create)?
Yes    No
Many Emails: Would you like to receive notifications IMMEDIATELY?
Yes      No
Delivery Type:
Whole Thread      New Part Only
Daily Digest: Would you like to receive notifications ONCE A DAY?
Yes      No
Classifieds - Many Emails: Would you like to receive ALL classified notifications IMMEDIATELY via email:
Yes    No
Classifieds - Daily Digest: Would you like to receive ALL classified notifications ONCE A DAY via email?
Yes    No

Additional Questions:

1.

CONTACT INFO:

Mother Cell Phone:

2.

Mother Work Phone:

3.

Father Cell Phone:

4. *

Father Work Phone:

5. *

Emergency Contact name & relation (other than parent):

6. *

Emergency Contact Home Phone:

7.

Emergency Contact Cell Phone:

8.

MEDICAL CONCERN: 

  • State child(ren)'s name and condition, if applicable
  • List Medication to be administered (if needed).  
  • Medical Protocol to follow should a problem arise (please include symptoms to look for as well as treatment plan you would like us to follow, complete with who to contact)

9. *

Medical Insurance Provider

10. *

Group #

11. *

Policy #

12.

Hospital Preference

13. *

RELEASE OF LIABILITY AND GENERAL AGREEMENT - FAMILY MEMBERS:  Please list first and last name of each family member who is likely to come on campus - i.e. parent,  legal guardian, each child in the family (even those not attending Co-op) and extended family)

(hereinafter referred to as "Family") in consideration of being permitted to participate in The Upstate Homeschool Co-op, agree to the Release of Liability and General Agreement (agree at bottom).

14. *

TYPE OF FAMILY: Please select the type of Family you represent:

Returning Family New Family

15. *

HOMESCHOOL ACCOUNTABILITY: Under which South Carolina Homeschool option are you legally registered to homeschool?

Option 1 Option 2
Option 3 None yet- only K4 or K5 student

16. *

If you are registered under Option 3, list the name of your accountability association.  If you are registered under options 1 or 2, list n/a.

17. *

GRADE LEVEL: The student(s) I am registering are taking classes in the following grade level(s) OR I am teaching class(es) at co-op in the following grade level(s):

(1 required)
Elementary School Middle School
High School

REFERENCES: Acceptance into UHC is contingent upon follow-up of references. You must have a pastor, church leader, or current Upstate Homeschool Co-op member complete this Referral Letter and sign.  It must be emailed by the reference to an Administrator prior to registration day.  Instructions are in the form.

DIGITALLY SIGN FORMS: Agreement to the online forms below will serve as your "digital signature", so please read carefully before agreeing at the bottom.  Since you are filling out Registration Forms online, it will NOT be necessary to print these forms. 

18. *

  • I hereby affirm the Statement of Faith
  • I have read the Volunteer Agreement and agree to fulfill my service responsibility
  • I have read, accept, and will abide by the Financial Agreement.
  • I hereby authorize Upstate Homeschool Co-op to seek medical attention for my child(ren) should the need arise.
  • I hereby release Upstate Homeschool Co-op from all liability to my family for any loss or damage as set forth in the Release of Liability Agreement.
  • I will read the Elementary and/or Middle School Student/Parent Contract and I agree that I will oversee my student and help him/her keep the terms, conditions, and privileges described therein.
  • My High School-age students will read and will comply with the terms of the High School Handbook, and will sign the student contract when asked to do so.
Yes - I agree to all of the above No - cancel this registration

19. *

Spouse is in agreement:

yes - I agree to all of the above no - cancel this registration
N/A (single parent)

20. *

By checking the box below, I acknowledge that registration is not official until I have attended an on-site registration day, registered for individual classes there, signed up for volunteer hours, and financial payment has been received.

 

(1 required)
Yes, I understand

Type in the text that you see above: