Team Member Name: _________________________________________

Parent’s Name: _________________________________________

Home address: _______________________________________________

_______________________________________________

Best contact phone number:_____________________________________

Best contact alternate phone:____________________________________

Team Member Age:___________

Team Member Date of Birth:____________________________________

Verification of Albuquerque Homeschool Enrichment Community (AHEC) membership

Is your family a member of AHEC? YES NO

In case of emergency

Alternate Point of Contact:________________________________________

Alternate Phone:________________________________________________

Alternate Phone(2):______________________________________________

Is a computer at home available without disrupting the family usage? YES NO