Lebanon Area Homeschoolers
Shared Learning Enrollment Form

FAMILY INFORMATION:

All fields in this section are required
Last Name:	Father:	Mother:
Address:
City,state,Zip:
Telephone:	Email:
Cell Number:	Emergency Contact Name/Phone:

VOLUNTEER ASSIGNMENT:

Each family is required to serve in either one Teaching position, two class asistant positions, Or help on the cleanup crew, *Positions must be pre-approved by Enrollment Coordinator.	Volunteer Position #1:
	Volunteer Position #2:

CHILD/CLASS INFORMATION:

Child's Name
Child's Grade/Age
Shared Learning Classes 1:00-4:00 pm
1^st Hr. 1:00
2^nd Hr. 2:00
3^rd Hr. 3:00
Class fees	$	$	$	$	$	$
Location Of Parent During Shared Learning (For Emergengy Purposes)
1^st Hr.		2^nd Hr.			3^rd Hr.

ENROLLMENT/CLASS FEES:

Shared learning family fee $10.00 Per semester:	$	Class Enrollment is Accepted on a First-Come Basis Class Fees are Non-Refundable
Total Class Fees (if applicable):	$
Total Amount Due:	$