Evangelical Presbyterian Home Education Ministry

Evangelical Presbyterian Home Education Ministry
(EPHEM)
Family Registration Form for 2007-2008 School Year
Registration Deadline is June 30, 2007

Family Information:

Last Name: ______________________

County: _________________

Father: _________________________

Email: ___________________

Mother: ________________________

Home Phone: _____________

Address: _______________________________

City: ________________________

State:______________ Zip: ________________

I am a member and regularly attend a PCA Church. Name of Church:

________________________________

I can receive Word documents as email attachments:

Yes/No

I am a member of the Homeschool Legal Defense Association:

Yes/No

Number of years homeschooling (not including 07-08):

____________________

Student Information:

Please fill out one New Student Registration Form per child.

Fee:
Family Membership, $75	_______
Make Checks Payable To: EP Church

We have read and agree with the Guidelines for Participation (see Vision Statements and Core Values on web site). We have signed and are submitting the Request, General Release, and Indemnity Agreement (see Waiver on web site). We understand that there will be two mandatory meetings: July 30 - New Family Orientation and August 27 - Fall Parent's Meeting.

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Father's Signature

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Mother's Signature

Mail to: Evangelical Presbyterian Church, Attn: EPHEM, 710 Ridgely Ave., Annapolis, MD 21401

Office Use Only

Date Received	Number	Forms Ok	Check #/Amt	In Database	Email List	Letter Sent