Homeschool Roster Membership Form
PARENT/GUARDIAN
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Name (Add name if they will attend field trips.)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a new or returning family?
*
Returning
New
How did you learn about Homeschool Roster?
Friend
Was previous member
Facebook
Other
How are you registered to homeschool?
*
Independent
Umbrella School
Accredited Online (private) School
Virtual Public School
Name of county if Independent, or name of school if an umbrella or accredited.
*
CHILDREN
Child #1
*
First Name
Last Name
Grade and Age
*
Child #2
First Name
Last Name
Grade and Age
Child #3
First Name
Last Name
Grade and Age
Child #4
First Name
Last Name
Grade and Age
Homeschool Roster Membership
*
$35 - September 2022 - May 2023
Payment Option
*
Check (write to Ponomo - you will receive payment instructions)
PayPal (plus $1.50 service fee to homeschoolroster@gmail.com)
Venmo (plus $1.50 service fee to @homeschoolroster)
Any comments?
Submit
Should be Empty: