LEBANON AREA HOMESCHOOLERS

SHARED LEARNING ENROLLMENT FORM

Last Name:

Father:

Mother:

Address:

City, State, Zip:

Telephone:

Email:

Cell Number:

Emergency Contact Name/Phone:

Each family is required to volunteer in either one teaching position, two class assistant positions, or help on the cleanup crew.

*Positions must be pre-approved by Enrollment Coordinator.

Volunteer Position #1:

Volunteer Position #2:

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 Emergency Purposes)

1^st Hour:

2^nd Hour:

3^rd Hour:

Shared Learning Family Fee $20.00 Per Semester:

$

Class Enrollment is Accepted on a First- Come Basis.

Class Fees are Non-Refundable.

Total Class Fees (if applicable):

$

Total Amount Due:

$