Adults

Last Name:

_____________________________________________________

Address

_____________________________________________________

City:

___________________

Zip Code:

______________

Phone Number:

___________________

Cell Number:

______________

E-mail Address:

_____________________________________________________

His First Name:

___________________

His B-Day:

______________

Her First Name:

___________________

Her B-Day:

______________

Anniversary:

_____________________________________________________

Children

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Name: _______________________ Birthday:___________ Age: ______ Grade: ______

Miscellaneous

Years you have been home schooling (K-12):_____________________________________

Curriculum Used: _________________________________________________________

Your expectations of this support group: ________________________________________

                       __________________________________________________________

Church you attend: ________________________________________________________

Please return this form with your registration fee to: Janice Ryschon, 2218 N 92^nd Glen, Phoenix, AZ 85037

The registration fee is $30.00. Please make checks payable to JOY Home School Network. If you have any questions, please call Janice at (623) 939-6772 or you may e-mail us at [email protected].