Group Solutions - Membership Form

Membership Form

* Group:

Class Day (16 Fridays)
Club Tutorials (Tuesday and/or Thursdays)
Teacher/Tutor (Independent Contractor)

* Parent(s) Names:

* Street:

* City:

* Zip:

* Home Phone:

Cell Phone:

Fax:

* Email:

* How often do you check your email?

Never	Often
Seldom	Daily

Preferred mode of correspondence:

I prefer you call me
I prefer you email me

How did you hear about Group Solutions?
internet, friend, phone book, ACHEV, CASA, OTHER?

Who do you know that attends Group Solutions?

How long have you been educating your children at home?

Years

What other support groups do you belong? ACHEV, CASA, OTHER

Are you a current member of HSLDA(www.hslda.org)?

Yes

Children:

* What church do you attend?

* Denomination?

* Describe your relationship with Jesus:

* Do you belong to an ISP or have you filed an affidavit?

As a parent/teacher, in what of the following areas are you interested (i) or have some
knowledge (k)? Put a star by your 3 favorites!

* Write about your family and how you might benefit from being a part of Group Solutions:

* Describe any teaching qualifications you may have or teaching experiences (if any):