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HOMESCHOOL CONNECTIONS
Pre-Registration Form
First name of your child
*
Last name of your child
*
Birthday of your child
*
Month
Month
Day
Year
Name of your pediatrician
Your first name
*
Your last name
*
Your occupation
Other parent's first name
Other parent's last name
Other parent occupation
Does your child have special needs?
*
YES
NO
What are your child's learning needs?
What are your hopes and dreams for your child?
Does your child have siblings?
*
YES
NO
If you answered yes, how old are the siblings?
What languages are spoken at home?
*
What holidays or traditions are celebrated at home?
Was your child formerly:
*
in public school
in private school
homeschooling
other
Are you familiar with the process of homeschooling?
*
YES
NO
What do you expect from homeschooling?
What program are you interested in?
*
Core Program
Enrichment Program
Summer Program
I don't know
Is there anything else you would like us to know about your child?
Email
*
Phone
*
Address
*
How did you hear about us?
*
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