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MTHEA Family Registration Form

Membership Dues: $35 (date payment for July 1, 2010)

Make checks payable to MTHEA

Co-op/Tutorial Name: ___________________________________

 

Mother’s Name __________________ Father’s Name____________________ Last Name_____________________________
                                                                                                                                               

Address: __________________________________________________________________________________________________     

City:  ____________________________________________________________________________ Zip:_____________                                            

Home Phone: _________________________ Cell Phone: ___________________________________________

Umbrella School: _________________________________________________________
                       

Student’s Name                          Grade                      Age

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E-mail: _______________________   Would you like to join email group?  Chat c    Announcements c

Will you have a graduating senior in 2011?   Yes c  No c  

Number of years your family has homeschooled?  _______