Text Box: REGISTRATION  DEADLINE IS FRIDAY, DECEMBER 5, 2003
Text Box: CHESCA Registration WINTER, 2003	
Text Box: PLEASE PRINT YOUR LAST NAME


_______________________________
Text Box: Full Name: __________________________________________

Address:   ___________________________________________

                 ___________________________________________

Phone:      ___________________________________________
  
Nurture Group: ______________________________________
Text Box: All registrations MUST BE  postmarked on or before December 5, 2003.  Late registrations will not be accepted.  They will be returned with a $1 loss of credit (for P & H). Mark your calendar to be sure your registration is in on time.  Do your best to register early.  You will be put on a waiting list or have money refunded if an activity is closed.

Read both sides of this form carefully.  fill out both sides completely.  Fill in all columns next to activities you desire to attend, and calculate cost.  Make your check payable to CHESCA, and mail it and this form to Kathy Burnett, address  below.
Text Box:  Read, check and sign to have your registration processed. 
     Understanding the natural risks involved in certain types of activities, I, the parent, agree that Christian Home Educators-Stark County Association (CHESCA) will not be held responsible for any injuries or accidents occurring in conjunction with any CHESCA activity that we attend.  (Isa. 65:23; Jer. 29:11).
     In addition, I have read the field trip guidelines.(Enclosed in this newsletter)  Check here for yes: [       ].   I agree to abide by them to the best of my ability, especially in regard to promptness, behavior, cancellations, no-shows, and designated alternate parent (18 yr. old sibling or another parent) if I am not able to attend the activity.

Signature:  _____________________________________________________  Date:_____________________________________

(OVER)

____ x $29 first-timer

____ x $26 repeater 

____ x $24 NC Y member

____ x $21 first-timer

____ x $20 repeater

____ x$18 NC Ymember

Gymnastics—Tuesdays, starting jaNUary 6

 2:30-3:30pm

PRESCHOOL

GYMNASTICS—TUESDAYS, STARTING JANUARY 6

1:45-2:30PM

Text Box: Mail to:   Kathy Burnett
               P.O. Box 509
               Magnolia, OH  44643
Text Box: ACTIVITY ACCOUNT BALANCE
These steps will help you calculate the total amount you owe for your activities.  You will use this information when filling out the sections in the above box.
Look at the return address on the last page of your newsletter.  Some of you will see a number in the box next to the CHESCA logo.  This is your activity account balance.  Subtract that amount in box #4.  (Remember to add $3.00 in box #2.) 
If there’s no number and  you have registered for a county activity before, your account balance is $3.00.  Subtract that in box #4.  (Remember to add $3.00 in box #2.)
If this is the first time you have registered for a county activity, your activity account balance is $0.00.  Your amount in box #4 will be $0.00. (Remember to add $3.00 in box #2.)

REGISTRATION FORM

Please fill out your form carefully and completely, including names and ages of all children attending an event.  If we have to call you to find missing information, it makes more work for our volunteers.  We appreciate your help in this.

 

 

EVENT

NAME OF PARENT(S)

ATTENDING

 

NAME & AGE (OR GRADE) OF

EACH CHILD ATTENDING

 

# PEOPLE X

COST/PERSON

 

TOTAL COST

 1

The diary of anne frank

Friday, january 26

10:00 am

 

 

____x $9.00 per seat

 

            

 

 2

 

 

 

 

 

 3

 

 

 

 

 

 

 4

Winter family camp

Friday, january 16, 17, 18

10:00 am—2:00 PM

 

 

____$ 10.00  per family

 

 

 

 #1                          Subtotal

 

 

# 2          ADD $3 Reg. fee

+ $3.00

  # 3                        Subtotal

 

#4           Subtract Activity

Account Balance

(See Below)

 

  -

 

#5               TOTAL OWED

 

 5

Lake farmpark

Friday, january 9

9:45 am—2:00 PM

 

 

____$ 3.00  per person