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Member Registration

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2017-2018 Registration Form

All fields are required, except where noted as optional.

New Membership
Renewal (if you have previously been a CHESCA member, what is your email address?

Contact Information

Father Name Home Phone Unlisted
Mother Name Work Phone (optional) Unlisted
Family Name Primary Email Address Unlisted
Address1 Secondary Email (optional) Unlisted
Address2 City,State,Zip
Business School District

Personal Information

Church (optional) Years in CHESCA
Registered Voter? Years homeschooling

Demographic Information

Please list your children's names and birth dates. Check the box before the names of children who will be home educated in the 2017-2018 membership year.
HSChild's NameBirthday HSChild's NameBirthday
Family's occupation / business (optional)
Knowing your family's occupation or business can help in contact for educational assistance, apprenticeship, and so members can direct their business to other CHESCA families if they desire. CHESCA does not sell or give away its membership information.
Family's interests/hobbies
Current curriculum

Fee Information

CHESCA Central Fee $
CHESCA members join through one primary CHESCA nurture group. Some families choose to join more than one CHESCA Nurture Group. Both CHESCA Central and each CHESCA Nurture Group have separate fees. The fees for each group are not all the same. Please check the web site for the current information on each group including who the check should be made out to and where it is to be sent. All fees associated with this membership form are sent as one check to the primary CHESCA Nurture Group. They will disburse the monies accordingly and forward copies of your information to any other nurture group you are joining. There is no need for you to duplicate any paperwork.
Primary Nurture Group selection: $
Additional Nurture Group selection (optional): $
Additional Nurture Group selection (optional): $
Directory Information
Include me in the CHESCA directory (printed in October)
Mail me in a CHESCA directory (optional - $0.00 - it is available online) $
Place my ad in the CHESCA directory (optional = $4.00 - we will contact you for a business card or ad content) $
Mail me the CHESCA newsletter (optional - $0.00 - it is available online) $

Contractual Information

I have read and understood the information in the CHESCA and Community Schools Document and certify that I am a home educator as defined therein.
I have read and agree with the CHESCA Statement of Faith. (At least one parent must agree with the Statement of Faith. The second parent may choose to disagree with the Statement of Faith, but must agree not to oppose the other spouse's membership in CHESCA for the membership year.)

Payment Information

I will pay online with PayPal/CreditCard (preferred)
I will send a check to my Primary Nurture Group secretary (address will be provided on the next page)
I have made other arrangements:


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Mail: P. O. Box 8801, Canton, OH 44711

[© 2018 CHESCA, P. O. Box 8801, Canton, OH 44711, 330-588-6142]