YEAH : Youth Educated At Home

Providing Opportunities for Home Educated Students in Middle, Junior and Senior High School

Member Registration Form: 2007–2008

NOTE: Memberships must be received by June 30 of any given year to be considered as current YEAH members for The Academy fall registration deadlines.  Memberships received between July 1-31 will be counted for the following year and become official on August 1.  Renewals are due with or before The Academy class registration to keep your YEAH membership current for The Academy registration basis.   Print, fill out and submit this form for NEW or Annual Renewal.

Family Last Name _________________________ Parent(s) 1^st Name(s)___________________________________

Student 1^st Name _________________________ 2007-08 Grade: _______ Birthday (incl year)_____________

Student 1^st Name _________________________ 2007-08 Grade: _______ Birthday (incl year) _____________

Student 1^st Name _________________________ 2007-08 Grade: _______ Birthday (incl year) _____________

Please indicate only students in grades 5 through post graduation who are eligible for YEAH membership. ATTN: Names of PSEO students who are interested in participating in YEAH 's Commencement Ceremony must be included in the above membership listing.

Address: ______________________________ City ______________________ State _____ Zip ______________

Phone: (_____) ______________

Family Email address: ___________________________  Student Email address : ___________________________

(Most YEAH correspondence will be sent via E-mail, please list the family E-mail address you want mail sent to)

Volunteers are needed to assist the YEAH Board members with various YEAH activities.  If possible, please check where your family can help.  Set up, take down & other labor is needed for: The Academy _____;  PLAN testing ____; Workshops ____; Graduation _____ ; Other: _____________________________  

Please enclose $15.00 per family registration fee (with an E-Mail address for correspondence) or $25.00 per family without E-Mail or wanting Postal Mail service. – Checks payable to YEAH .

    _____$15.00           _____$25.00

Mail to: YEAH 5532 Saint Stephen St., St. Paul , MN 55112-1235

YEAH Liability Waiver: must be signed by a parent before membership can be accepted.

We understand that our participation in any activity sponsored by Youth Educated At Home (hereafter called YEAH ) may incur risk, however slight, or injuries to ourselves or our child(ren), or theft or damage to personal property. We agree for ourselves and our child(ren) participating in activities with YEAH to hold harmless YEAH ! or the owners of any facility we utilize and all members, workers, and employees of these entities from any and all liability whatsoever for any injury, condition, or other problem associated with and all liability whatsoever for any injury, condition, or other problem associated with the child’s participation in activities of said YEAH In consideration of accepting my family’s application, I hereby for myself, my child(ren), my heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child(ren) may have against YEAH , its officers, representatives, successors or members for any and all injuries or losses suffered by myself or my child(ren) at any activity sponsored by YEAH I agree to assume all financial responsibility for the medical expense incurred, as a result of said YEAH activities, for the care of myself, my spouse, or my child(ren).

Student Name(s) ______________________________________________________________________________________

__________________________________ ______ ___________________________________________________ _______

 Father’s Signature _{_________________________________}  Date _______  Mother’s Signature _____________________________ Date ____________