Homeschool Class Request Parent/Guardian Name* First Last Phone*Second Phone #:Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code I am requesting placement in:* Pioneer Homesteading Lewis & Clark: Explorers Day and Time that would work best for me: We will get in touch with you to arrange which class you will be attending.First child name:* First child age:* Second child name:* Second child age:* Notes about special needs, allergies, or custody issues we should be aware of:How did you hear about us?* newsletter email website flier/advertisement Social Media Children attending may be in photographs/videos of activities happening at homeschool, taken by instructors or other parents, but we will not identify your child by name on our website or in printed materials unless we receive explicit permission from you.* Agree I release Singing Creek Educational Center and it's staff, volunteers, and Board Members from any liability resulting from accident or injury to myself or my family members, including children, due to any reason including negligence.* Agree One homeschool class session Quantity* Price: $15.00 Quantity Please pay for your first session at the time you submit this form. After your first class if you'd like to commit for the rest of the year we will bill you.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
