Test Registration Form

Membership Registration Spring 2021

2021-2022 Talking Stick Family Membership Registration
This is a multi-page form that may require several minutes to complete. Once you enter the required information on each page, the blue Next button will take you to the next page. If you need to return to a previous page, you can use the Previous button at the bottom of the page. On the last page, there will be a Submit this Registration button which will submit your information and complete your registration.

Let's Begin!
Number of Children*
How many children from your household do you wish to register today?
What is your relationship to this child/children?*
Your Child's Name*
First Name Last Name
Your Child's Date of Birth*

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Your Child's Age*
How old will your child be on September 1, 2021?
Please list your child's allergies, if any:
Additional information about this child:

Second Child
Your Child's Name*
First Name Last Name
Your Child's Date of Birth*
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dd
yyyy
Your Child's Age*
How old will your child be on September 1, 2021?
Please list your child's allergies, if any:
Additional information about this child:

Third Child
Your Child's Name*
First Name Last Name
Your Child's Date of Birth*
mm
dd
yyyy
Your Child's Age*
How old will your child be on September 1, 2021?
Please list your child's allergies, if any:
Additional information about this child:

Fourth Child
Your Child's Name*
First Name Last Name
Your Child's Date of Birth*
mm
dd
yyyy
Your Child's Age*
How old will your child be on September 1, 2021?
Please list your child's allergies, if any:
Additional information about this child:

Fifth Child
Your Child's Name*
First Name Last Name
Your Child's Date of Birth*
mm
dd
yyyy
Your Child's Age*
How old will your child be on September 1, 2021?
Please list your child's allergies, if any:
Additional information about this child:

About You and Your Family
Hi! Are you a new or returning family?*
- New
- Returning
Your Name*
First Last
Your Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Phone*
This is what we will use if we need to contact you about your child during programming.
Your Neighborhood*
Photo Release*
Harmony Learning Community may use photographs or video taken of my child/children for Harmony Learning Community's publications, website, blogs and social media.
Online Risk Acknowledgement*
- yes, I acknowledge my responsibility
I acknowledge that the internet has some basic inherent risks. Harmony Learning Community will do its best to ensure a safe environment, but as parent/guardian of this child, I acknowledge it is my responsibility to talk them about internet safety, particularly around online classes. By checking the above box, I am agreeing that I assume this risk and do not hold Harmony Learning Community or any of their facilitators liable.
How did you discover Harmony Learning Community?
We're glad you are joining us!
We are homeschoolers and know there are a lot of different options and programs out there. Would you care to share a sentence or two about how you discovered Harmony Learning Community? This helps us learn how effectively we are reaching the community.
What does Harmony Learning Community mean to you and your family?
We're glad you are back!
Thanks for continuing to support Harmony Learning Community! We are excited you and your family are joining us for another program year. Would you care to share a sentence or two about what Harmony Learning Community means to you and your family? We'd love to publish your thoughts on our website.

Membership Costs
Financial Aid
We have a limited amount of financial aid available. We base our decisions on a case-by-case basis after considering several factors, including household income.

The majority of our financial aid is funded by our community.
- I would like to apply for financial aid.
Sliding Scale*
Our membership is available on a sliding scale from $200 to $500. We ask those who are capable of paying full price to please do so that we may be able to accommodate those with financial hardships during this time. Please enter the amount you will pay in the blank above.
Is there anything else you would like us to know?
Thank You
Thank you for joining our community with our Harmony Learning Community Family Membership! You will be receiving a confirmation email and invoice.
Comments
This field is for validation purposes and should be left unchanged.

Membership Registration Spring 2021

2021-2022 Talking Stick Family Membership Registration

Let's Begin!

Second Child

Third Child

Fourth Child

Fifth Child

About You and Your Family

Membership Costs

Thank You