Parents as Teachers in Christian Homes
2007-08 Membership Form
Annual Dues: $20
Make checks payable to PATCH. (In memo of check please write “PATCH Dues”)
Send completed form and money to:
Amanda Doublin, Treasurer
PATCH
P.O. Box 44
West Paducah, KY 42086
ENROLLMENT FORM: (please print)
Name: ______________________________________________________________
Last Name Husband’s First Name Wife’s First Name
School Name: ________________________________________________________
Address: ____________________________________________________________
Address/P.O. Box Number City/State Zip Code
Phone: ______________Cell: ______________E-mail:______________________
CHILDREN:
Name:_______________________ Date of Birth: ______________ Grade: ______
Name:_______________________ Date of Birth: ______________ Grade: ______
Name:_______________________ Date of Birth: ______________ Grade: ______
Name:_______________________ Date of Birth: ______________ Grade: ______
Name:_______________________ Date of Birth: ______________ Grade: ______
Name:_______________________ Date of Birth: ______________ Grade: ______
(If you need more room please write on the back of form.)
How many years have you been home schooling? ______________
What curriculum(s) do you use? _________________________________________
______________________________________________________________________________________________________
Do you have a home business, owned business, or service?
____________________________________________________________________
Name of Business/Service Phone Number