New Harvest Co-op Application

New Harvest Co-op Application
Date

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Information
Mother's Name *

First Name Last Name
Father's Name

First Name Last Name
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
E-mail *
STUDENT INFORMATION

Please fill out the following questions about your children starting with your oldest. This will help us to plan for the upcoming year.
Does your child have any health concerns the co-op needs to be aware of?
How did you hear about Harvest Co-op?
How many years has your family been homeschooling? *
If your children have attended school please explain the reason for leaving.
Please list any members of Harvest Co-op you may know. If you do not know any members of Co-op please list at least 2 references we may contact.
Please choose the age group/groups you are comfortable teaching.

K4/K5 1st/2nd 3rd/4th 5th/6th 7th/8th 9th/10th 11th/12th
From the subjects listed below, please choose at least three general subjects you would be interested in teaching.
Subject(s) you are least interested in teaching: *
Do you have any special gifts or talents that may benefit co-op? *
If you would like to share any additional information about your family, please use the space provided below.
Would you like to be put on a waitlist if you’re child’s class is full?

Yes No

SPIRITUAL BACKGROUND
Name of church you attend:
Please give us a brief description of your testimony and walk with Jesus and any additional comments you may have.
Thank you for your interest in New Harvest Co-op.

Please select the 'Submit' button to complete your application.
Should be Empty: