Homeschool Co-op Registration Form
Etz Chaim Academy
Parent:
*
First Name
Last Name
Parent Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Email:
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Name:
*
First Name
Last Name
Student Birth Date:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Age:
*
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 per student)
Bible Based ABC’ & 123’s (PreK-1) ages 3-6 $20
Shape Artists (PreK-1) ages 3-6 $20
Story Time Music & Movement (PreK-1) ages 3-6 $10
Animals Around the World (PreK-1) ages 3-6 $20
Drama (LE) Grade 2-3) $10
Eco Systems (LE) Grade 2-3) $20
Yeshua’s Character (LE) Grade 2-3 $20
Hebrew (LE) Grade 2-3 $15
Biblical Character Development (UE) Grade 4-5 $20
Mixed Art (UE) Grade 4-5 $30
Body Book/ Anatomy (UE) Grade 4-5 $20
Book Club (Ages 9+) $10
Debate (M-HS) $10
Baking (M-HS) $35
Group Guitar (M-HS) $10
Sketching (M-HS) $30
Drama (13+) $10
Messianic Dance (Ages 10+) $10
Nursery (Babies & Toddlers)
If selecting "Private Music Lessons" please indicate what instrument in the box below: (Coming Soon)
Parent Signature:
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