Christian Home Educators of Northeast Mississippi

Returning Membership for CHENM - 2023/2024 School Year

Father's Name

First Name

Last Name

Mother's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Contact Phone Number

(###)

###

####

Church You Attend

Student Section

Child 1

First Name

Last Name

Child 1 Birthdate

YYYY

Child 1 Grade

What grade will Child 1 enter for the 2022-2023 school year?

Child 2

First Name

Last Name

Child 2 Birthdate

YYYY

Child 2 Grade

What grade will Child 2 enter for the 2022-2023 school year?

Child 3

First Name

Last Name

Child 3 Birthdate

YYYY

Child 3 Grade

What grade will Child 3 enter for the 2022-2023 school year

Child 4

First Name

Last Name

Child 4 Birthdate

YYYY

Child 4 Grade

What grade will Child 4 enter for the 2022-2023 school year

Child 5

First Name

Last Name

Child 5 Birthdate

YYYY

Child 5 Grade

What grade will Child 5 enter for the 2022-2023 school year?

Child 6

First Name

Last Name

Child 6 Birthdate

YYYY

Child 6 Grade

What grade will Child 6 enter for the 2022-2023 school year?

Child 7

First Name

Last Name

Child 7 Birthdate

YYYY

Child 7 Grade

What grade will Child 7 enter for the 2022-2023 school year?

Child 8

First Name

Last Name

Child 8 Birthdate

YYYY

Child 8 Grade

What grade will Child 8 enter for the 2022-2023 school year?

Child 9

First Name

Last Name

Child 9 Birthdate

YYYY

Child 9 Grade

What grade will Child 9 enter for the 2022-2023 school year?

Returning Members

Returning Membership for CHENM - 2023/2024 School Year

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