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membership Based Homeschool Enrichment

2025-2026 Membership-Based Homeschool Enrichment Program Enrollment (10/3/25-5/15/26)

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Membership-Based Homeschool Enrichment Program Enrollment (10/3/25-5/15/26)

Student Information

How did you hear about us?(Required)
Legal Name (as stated on Birth Certificate)(Required)
MM slash DD slash YYYY
Legal Gender(Required)
Address (Where Student resides most of the time)(Required)

Parent/Guardian Information

Parent/Guardian Name(Required)
Parent/Guardian Address(Required)

Parent/Guardian Signature

Consent(Required)
Please Sign As The Parent/Guardian Completing The Registration
Parent/Guardian Signature (Print)(Required)
MM slash DD slash YYYY