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2008-2009 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
	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 2008-2009 membership year.
HS	Child's Name	Birthday	HS	Child's Name	Birthday






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 Late fee applied (deadline was 2008-06-20)		$
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 - $6.00 - 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 - $4.00 - it is available online)		$
TOTAL DUE		$

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
Office: 2686 Easton St NE, Canton
Phone: 330-491-9857