CHRISTIAN HOME EDUCATORS OF THE MOUNT PLEASANT AREA

“CHEMPA” MEMBERSHIP REGISTRATION FORM

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APPLICATIONS FROM NEW FAMILIES WILL BE HELD

UNTIL ONE OR BOTH PARENT(S) HAS/HAVE ATTENDED

A CHEMPA NEW FAMILY ORIENTATION MEETING.

 Printable Form

www.chempa.org

This form may be mailed to CHEMPA at P.O. Box 2331, Mt. Pleasant TX 75456.  In order to receive a monthly newsletter and annual membership directory, this form must be submitted with dues payment by the deadline set by the current CHEMPA Board of Directors.  The information submitted on this form will be included in a membership directory, as well as an internet “Yahoo Group” available only to CHEMPA members.  The Yahoo Loop is a private e-mail loop whereby members communicate opportunities, items of interest, and activity changes between newsletters.  When your membership form is processed, you will be receiving an e-mail invitation to join the Yahoo Loop; please respond quickly so as not to miss CHEMPA news.  If you are unfamiliar with how a Yahoo group/loop works and want to know more, please contact the Yahoo Moderator at chempatx@yahoo.com or contact an officer.  PLEASE PRINT CLEARLY

Family’s Last Name: _________________________________________________________

Father’s Name: ______________________ Mother’s Name: ________________________

Address: ___________________________ Phone Number: _________________________

City: _______________________________ State: _______________ Zip: _____________

E-mail Address: _____________________________________________________________

Curriculum: ________________________________________________________________

Place of Worship: ___________________________________________________________

Please list all children, including adult graduates and pre-school age children:

“CHEMPA” MEMBERSHIP REGISTRATION FORM

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CHEMPA membership requires that families read, understand, and agree to abide by the “Mission Statement” and “Standards Of Behavior”.  Please check the boxes, sign and date below.

        I have read the “Mission Statement” of

CHEMPA and agree to abide by it. 

        I have read the “Standards Of Behavior” of

CHEMPA and agree to abide by them.

Parent Signature: _____________________________________ date: __________ 

CHEMPA Teacher I.D. cards are available upon request. 

_____  Please issue a CHEMPA I.D. card for my family. 

_____  No thanks.  I am not requesting a CHEMPA I.D. card for my family. 

DUES OPTIONS ~~ Please circle your preference below.

Checks should be made payable to CHEMPA. 

From July 1 through March 31, dues are full price.

For families who join late in the school year (between April 1 and June 30),

“short memberships” are available wherein dues are half-price.

Every family must pay dues and complete this membership form at the beginning of every new school year.

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