RCHEA

 

2011 – 2012 Registration

Roane County Home Education Association

(All information given in this application will be kept confidential)

Family Information

Last Name:
Father:	Mother:
Address:
E-Mail Address:	Phone:

Student Information

Students Name	Date of Birth	Age	Grade

Other Information

What function will you or your family be contributing to the group? (Teaching, Cleaning, Planning, etc.)

Umbrella School/Home School Registration: __________________________________________

Are you a member of the Smoky Mountain HEA? Yes No

Will you be participating in Enrichment Classes? Yes No

Can we use your contact information in the Yes No

RCHEA Member Directory?

RCHEA Registration $10 Paid: Yes No

Check #: _______ Date: __________

Mail Completed Form with Payment to:

R.C.H.E.A.

c/o Becky Kollett

401 Morton Road

Harriman, TN. 37748