Home School Enrichment Application Home School Enrichment Application What is an Enrichment Homeschool Program? * A model where children split their time between a traditional school setting and homeschooling. * Children are dropped off and taught in a classroom setting by paid teachers (may include parents). * Parents are responsible for the additional education of their children on the days between the in-person learning days. Mother's name(Required) First Last Father's name(Required) First Last Email (To use for all of communication)(Required) Mother's Cell(Required)Father's Cell(Required)Which Church Will You Be Homeschooling With(Required)This is a 36 Week Program. Grades K to 8th grade Holy Martyrs Chaldean Church - Tuesday & Thursday 9am-3pm St. Thomas Chaldean Church - Monday & Wednesday 9am-3pm How Many Children Will Be Registered ($100 Registration Fee)(Required) 1 2 3 4 5 6 NOTE: This would be refundable if we do not receive the minimum number of studentsName of Child 1(Required) First Last Name of Child 2(Required) First Last Name of Child 3(Required) First Last Name of Child 4(Required) First Last Name of Child 5(Required) First Last Name of Child 6(Required) First Last Mailing Address(Required) Street Address City State / Province / Region ZIP / Postal Code What church are you a registered parishioner at?(Required) Children's names, age/grade for Fall 2024 and last sacrament received. Please only include children who will be attending co-op days. Older children not attending do not need to be listed.(Required)Have you taken the Virtus training (Protecting God's Children) within the past 7 years?(Required) Yes No Not Sure Please describe anything additional we may need to be aware of (ie., allergies, behavior issues, additional children, comments, and/or questions).(Required)Please type in NONE if nothing additional Would you be willing to volunteer? If so, how often (once a week, twice a week, once a month, other)(Required) Coupon Code (if you have one) Total Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Δ
