Membership Application 2008-09

Moultrie C.H.A.T. (Christian Homeschoolers Associating Together)

Statement of Agreement:

___ I/We have read the Constitution of Moultrie C.H.A.T.  and we are in agreement with the statements of purpose and belief of this organization.

Signature: ______________________________Date:__________ 

Signature: ______________________________Date:__________

A copy of the Constitution is included in the information packet for new members, and is posted

on the website www.moultriechat.com  for members review. Membership is open to all Christian

home educating families whose conviction is to religiously educate their children, who

are in agreement with the statements of purpose and faith of this organization, and who

agree to abide by the guidelines.

 

Please print the name(s) of the parent(s) residing in the household, as you would like it to

appear in the database.  Contact information will only be shared with other Moultrie CHAT

members.

Father _____________________   Mother ________________________

Birthday ____________________     Birthday ______________________

Street Address ______________________________________________

City _________________________  State ________  Zip ____________

Home Phone __________________  Cell Phone ___________________

Email __________________________________
 

Where do you attend church? ________________________________________

 

Pastor’s Name ____________________________________________________
 

What is your PRIMARY reason for home schooling?

 

Where did you hear about us? ____________________________________________

 Moultrie Observer / Public Library   / Three R’s Resources / Radio /

Website / Friend / Board of Education / Other 

COMMENTS & SUGGESTIONS Please give us your ideas, comments on the back.  

Children in your Home School: Give Birthdate/Grade/Curriculum

 

NAME	BIRTHDATE	GRADE	CURRICULUM YOU ARE USING
1. _________________	________________	______	__________________________________
2. _________________	________________	______	__________________________________
3. _________________	________________	______	__________________________________
4. _________________	________________	______	__________________________________
5. _________________	________________	______	__________________________________
6. _________________	________________	______	__________________________________

 

 

 

 

 

 

 

E_MAIL ACCOUNTS 

Each family will be given a free forwarding e-mail account using the mother’s name.

ie. First.Last@moultriechat.com   If you would prefer a non-forwarding web based

e-mail account, please indicate so here. 

 YELLOW PAGES

 We would like offer to CHAT Members Only a business directory of businesses

owned or run by our fellow home school families. This is NOT to expect discounts

or favors but rather to encourage home school families to support other home

school families’ businesses when they have the need of that service. If you

have a business that you would like to list in our Home School Yellow Pages,

please give the information below.

 

NAME OF BUSINESS __________________________________________________

 

Contact Person ______________________________________________________

 

Business Address ____________________________________________________

 

Phone Number ______________________________________________________

 

Website ___________________________________________________________

 

E-mail _____________________________________________________________

 

Brief Description:

 

 

 

 

 

                                   August 2008 - July 2009

MEMBERSHIP FEE:  $75   (Early Bird – If paid in full by August 1 - $65)             $ _______

Limited scholarships available. See membership director.

Note: additional lab/supply fees for some classes.

 

God’s World News (a Christian World View “Weekly Reader” type subscription)

OPTIONAL at a discount through the co-op.  World Magazine is available for

high school, please contact Payge Ladson for more information.  

   Circle Grade Level(s) you desire to receive:

   Early Edition / Taking Off / News Current / Top Story

   PreK-1^st            2^nd & 3^rd        4^th & 5^th             6^th-9^th

 Add $8.25 for each subscription to your fee. (not available after Aug 26)        $ ________

 

T-Shirts ~ Royal Blue Shirt ~ Same design as last year

Short sleeve T-shirts                                          

    Youth - $8                             Adult - $9        

______  X-Small   (2-4)               _______ Small             ______  Adult XXL ($10) 

______  Youth S  (6-8)               _______ Medium           ______  Adult XXXL ($11)

______  Youth M (10-12)             _______ Large  

______  Youth L  (14-16)            _______ Extra Large  

 $________ Total Cost +             $________ Adult      +        $ _______  extra size    =   $ ___________

 

 Long sleeve T-shirts

    Youth - $10                             Adult - $11        

______  X-Small   (2-4)               _______ Small             ______  Adult XXL ($12) 

______  Youth S   (6-8)               _______ Medium          ______  Adult XXXL ($13)

______  Youth M (10-12)             _______ Large  

______  Youth L   (14-16)            _______ Extra Large       

 $________ Total Cost +             $________ Adult      +        $ _______  extra size   =   $ ___________

TOTAL FEE                                                                                             $ _________

Less Amount Paid                                                                               $ _________

 Total Due                                                                                                     $ ________

PLEASE MAKE CHECKS PAYABLE TO MOULTRIE C.H.A.T.    

Limited Scholarships Available.

For More Information Contact:

Margie Holman, Membership Director  (229) 985-6635

Moultrie CHAT;  P.O. Box 1326,  Moultrie, GA 31776