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indicates a required answer

1. *

Parent Attending HSN
2. *

Phone Number
3. *

Email
4. *

Address
5. *

City
6. *

State & Zip
7. *

Church Affiliation
8. *

Religious Preference
9. 

If other, please specify
10. *

Martial Status
Single Married
Divorced Seperated
Widowed
11. *

Have you or your spouse ever been arrested?
Yes No
12. 

If yes, please explain when, why, and the outcome.
13. *

What year did you start homeschooling?
14. 

Name of family business or service.
15. *

Hobbies, interests, or teaching experience.
16. *

Areas interested in serving/contributing at Co-op: (subjects to teach, activities/committees to plan/serve on, talents, etc.) 
17. *

What hours are you interested in attending HSN?

 (1 required)
Full day Half Day

Additional Parent Information
18. *

First and Last Name
19. 

Address (if different from above)
20. *

Phone Number
21. *

Email

Student Information #1
22. *

First and Last Name
23. *

Date of Birth
24. *

Grade Level (for August 2025)
25. 

Email (if different from above)
26. 

Phone Number (if different from above)
27. *

Health, Behavior, or Learning Challenges?

Student Information #2
28. 

First and Last Name
29. 

Date of Birth
30. 

Grade Level (for August 2025)
31. 

Email (if different from above)
32. 

Phone Number (if different from above)
33. 

Health, Behavior, or Learning Challenges?
34. 

If you have additional students please list requested information for each student.
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