New Harvest Co-op Application

New Harvest Co-op Application
Date

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Information
Mother's Name*

First NameLast Name
Father's Name

First NameLast Name
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone 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.
Type a question
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/K51st/2nd3rd/4th5th/6th7th/8th9th/10th11th/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?

YesNo

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: