Parents' Names: ____________________________________________________________________
Address: __________________________________________________________________________
Email address: _____________________________________________________________________
City: ____________________________________ State: ________________ Zip: _______________
Phone: ___________________________________________________________________________
Children at home: (list additional children on the back please)
Name
Date of Birth
Interests
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
1-yr subscription/membership (July 1-July 1)
$20.00
(sign up before July 1st and take a $5.00 discount off membership)
(sign up by August 31 to be included in the directory)
Winter Recreation Days at the gym by the Pendleton Library $10.00
Newsletter only
$10.00
Check Total: (Send check or money order, no cash please)
$__________
I (we) the undersigned have read and agree to uphold the bylaws of Pendleton Home School Association.
_____________________________________________________________________________(Date)
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Please sign up for at least one activity unless you check "newsletter only".
____ I wish to be a "newsletter only" member, and do not plan to attend the activities.
Field trips: Oct ___ Nov ___ Dec ___ Jan ___ Feb ___ Mar ___ Apr ___ May ___ Dec. Caroling ____
Host Mom's Meeting: Oct ____ Jan ____ Apr ____
Publicity: (contact the newspaper about PHSA events) ____
Coordinate Play Days: ____
Which day of the week is best for you for field trips? M ___ T ___ W ___ Th ___ F ___ S ___
Is morning best? _____ Afternoon? _____
Which day is worst for field trips? M ___ T ___ W ___ Th ___ F ___ S ___
Which evening is best for Mom's Meetings? M ___ T ___ W ___ Th ___ F ___ S ___
If you have suggestions for field trips, topics for Mom's get togethers, or other comments, please put them here. Please share what curriculum you use here. Please continue on bottom of back side if needed.
__________________________________________________________________________________________
Name ___________________________________ phone ________________ email_________________
Please be sure to fill out all spaces as this form is torn apart and given to different PHSA officers. Thanks.
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