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Registration
Exchange babysitting, meals, homeschooling classes, etc
Return to Family coop Info Page
Family Co-Op Registration Form
The contents of this e-form and any attachments are confidential and are intended solely for Rites of Passage Learning Center. The information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly prohibited. If you are not the intended recipient, please immediately
notify
Rites of Passage Learning Center at ritesofpassage@moorishrites.com and
delete
this message and its attachments, if any.
*
Indicates required field
Name
*
First
Last
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Are you on Facebook?
*
Yes or No. If yes, what name do you use on Facebook? You can find us on Facebook under Rites of Passage Learning Center. Please "Like/Share" our page!
Email
*
What is the best way and time to contact you?
*
We will contact you within a week. Let us know if we should call, email, or facebook you. Also what time or part of the day is best to contact you?
Services you want/need
*
Childcare
Meals
Tutoring
Homeschooling
Housekeeping/Repairs
All
Other (please explain in box to the right)
Please explain what "other" services you want/need.
*
If you checked "Other" for "Services I want/need, please explain what other services you want/need.
Services You can Provide
*
Childcare
Meals
Tutoring
Homeschooling
Housekeeping/Repairs
All
Other (please explain in box to right)
Please explain what "other" services you can provide.
*
Please list your (and or your family/team members') relevant skills/talents
*
Tell us about you and members of your household/company/team, so we know how to accommodate you. If there are more than 5 members, please write the others in the comments box below.
1
Name
*
First
Last
Age
*
1-6months
7-12 months
1-3 years
4-6
7-12
13-18
19-25
26-35
36-50
Over 50
Describe persons relationship to you
*
Me
Gender
*
Male
Female
2
Name
*
First
Last
Age
*
1-6 months
7-12 months
1-3 years
4-6 years
7-12 years
13-18
19-25
26-35
36-50
Over 50
Describe persons relationship to you.
*
Mother
Father
Friend
Husband
Wife
Daughter
Son
Grandma
Grandfather
Guardian
Aunt
Uncle
Co-worker
Other
Gender
*
Male
Female
3
Name
*
First
Last
Age
*
1-6 months
7-12 months
1-3 years
4-6 years
7-12 years
13-18
19-25
26-35
36-50
Over 50
Describe persons relationship to you.
*
Mother
Father
Guardian
Friend
Co-worker
Husband
Wife
Son
Daughter
Grandmother
Grandfather
Aunt
Uncle
Other
Gender
*
Male
Female
4
Name
*
First
Last
Age
*
1-6 months
7-12 months
1-3 years
4-6 years
7-12 years
13-18
19-25
26-35
36-50
Over 50
Describe persons relationship to you.
*
Mother
Father
Guardian
Friend
Co-worker
Husband
Wife
Son
Daughter
Grandmother
Grandfather
Aunt
Uncle
Other
Gender
*
Male
Female
5
Name
*
First
Last
Age
*
1-6 months
7-12 months
1-3 years
7-12 years
13-18
19-25
26-35
36-50
Over 50
4-6 years
Describe persons relationship to you.
*
Father
Mother
Guardian
Friend
Co-worker
Husband
Wife
Son
Daughter
Grandmother
Grandfather
Aunt
Uncle
Other
Gender
*
Male
Female
Comments.
*
Any suggestions or comments are appreciated. You may want to let us know of any special needs your family, company, team may have. For example, allergies, challenges, conditions, languages.
Rites of Passage Learning Center will contact you within a week.
We look forward to growing our village with you!
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