Homeschool Co-op Registration Form
Etz Chaim Academy
Parent:
*
First Name
Last Name
Parent Phone Number:
*
Please enter a valid phone number.
Preferred Contact Email:
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Name:
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First Name
Last Name
Student Birth Date:
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Month
/
Day
Year
Date
Student Age:
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Gender
Male
Female
Student Grade:
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Last completed grade level
Allergies/Medical Conditions:
List the allergy/condition and any special needs or instructions the co-op director and teachers need to be aware of.
Student Class Selections (Choose up to 4) If doing dance at 2:30 then choose 5:
Let’s get moving (Pre-K) ages 3-4
Bible ABC’s & 123’s (Pre-K) ages 3-5 $15
Heroes of the Bible (K-1) ages 5-7 $10
Busy hands arts & crafts (K-1) ages 5-7 $20
All about animals (PreK & K-1) ages 5-7 $15
Little Gardeners (PreK & K-1) ages 5-7 $10
Art Exploration (LE) Grade 2 & 3 $20
Trip around the world(LE) Grade 2 & 3 $15
Genesis Science (LE) Grade 2 & 3 $15
Heroes & virtues (LE) Grade 2 & 3 $5
Drama (UE) Grade 4 & 5
Messianic Dance (ages 9+)
Spanish (UE) Grade 4 & 5 $15
Watercolor (UE) Grade 4 & 5 $20
Book club (UE) Grade 4 & 5
Debate (M-HS)
Group Guitar (12+)
Art (M-HS) $25
Spanish (M-HS) $15
Drama (13+)
Baking (11+) $30
Nursery (Babies and Toddlers)
If selecting "Private Music Lessons" please indicate what instrument in the box below: (Coming Soon)
Parent Signature:
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