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Important: Delete this tip before you publish the form.Contact DetailsFather's Name(Required) First Last Mother's Name(Required) First Last Email(Required) Enter Email Confirm Email PhoneAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands First Child's Name(Required) First Last Nickname Gender(Required)MaleFemaleDate of Birth(Required) MM slash DD slash YYYY Age(Required)12345678910111213141516171819School Grade(Required)Second Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeThird Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeFourth Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeFifth Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeSixth Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeSeventh Child's Name First Last Nickname GenderMaleFemaleDate of Birth MM slash DD slash YYYY Age12345678910111213141516171819School GradeHow did you hear about this event?Social MediaGoogleWord of MouthRefer a FriendPast ParticipantOtherEvent Details1. Please summarize how you came to know Jesus Christ as your personal Savior and Describe the present condition of your Spiritual Life:(Required)2. What is the name of the church you Currently attend and status (Member/Regular Attender/Occasionally)(Required)3. List Church or Christian Service activities in which your family is currently involved:(Required)4. List parenting Classes you have taken:(Required)5. Summarize your parenting philosophy:(Required)6. Have any of your children: Been dismissed, expelled, or suspended Had any scholastic difficulty Has been clinically diagnosed with learning/emotional disorder Have a physical condition that we should be aware of 7. If yes to question 6, which children and explain any answers:8. Please describe your children's current spiritual condition:9.What curriculum will you be using to home educate your children this year?10. List any other homeschool co-op in which your family is currently involved:11. Our family would prefer to attend the co-op on: Tuesday Thursday Either For the Participating Parent Only12. I would like to participate in the Homeschool Support Group by serving as: (check all that apply) Lead Teacher Assist Teacher Either Both Age Level Nursery Preschool Kindergarten Early Elementary Upper Elementary Jr High Sr. High Any Age Group Early Elementary Art P.E. Vocal Choir Five in a Row Handchimes Science Drama Geography Fine Arts Art Vocal Choir Handbells Acting Other English/Writing Grammar Literature IEW Novel Writing Newspaper SAT Prep Other Foreign Language Sign Language Spanish German French Chinese Korean Latin Italian Other Sciences/Technology Physical Biology Chemistry Physics Computer Programming Robotics Electronics Other Math General Math Algebra Geometry Trigonometry Calculus SAT Prep Chess Other Social Studies Geography History Economics Political Science Other Extracurricular Classes P.E. Cooking Sewing Yearbook Study Hall Other Afternoon Clubs Odyssey of the Mind 4-H Leader Speech/Debate Legos Other Administrative Duties Support Group Leader Field Trips Organization Administration Resource Room Leader Consignment Sales If you checked Other above, please list below:Higher Educational Background: (List degree and major)In Addition, I have expertise, hobby or talent and could contribute to the group in this way:Submission of the Application: Space in the Homeschool Support Group is limited. Admission is based upon level of commitment, willingness for parental participation, and spiritual condition of child and parent. Complete and mail in this application to Capital Baptist Church by August 31, 2024.Capital Baptist Church 3504 Gallows Road Annandale, VA. 22003 (703) 560-3109 Ext 105 beagy@capitalbaptist.org Δ
