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Covenant Home School Resource Center
and
Covenant Classes
Intro Membership Benefits Membership Form Class Descriptions Class Schedule Teachers Policies
Transcript Preparation Service CHSRC Scholarships Positions Available Consultation and Tutoring
Membership Forms
Family Membership Form Co-op or Group Membership Form Payment Options
Please copy these forms to a word program. From there, you may either print the form, complete in hard copy and mail with your payment, or you may complete it in your program and send as an email attachment to info@chsrc.org and send your payment in the mail or by Paypal.
You are welcome to copy as many forms as needed.
Membership Levels: Description:
Basic Membership $30 Those wanting to make use of the services of CHSRC only, and not take classes
Enhanced Membership $35 Those wanting to take classes and access all the other services. Includes insurance
while students are in classes.
Basic Member Upgrade $5 Those who started with Basic Membership and decided to also take classes
Group Membership $50 + 5 or more families in a group setting such as a support group, co-op, or private school.
Access is given to some of the family membership benefits and some discounts.
Printer Friendly Family Membership Form (Needs Adobe Reader to view. Download for free)
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CHSRC Family Membership Registration Form
Printer Friendly Family Membership Form (Needs Adobe Reader to view. Download for free)
Covenant Home School Resource Center and H.O.M.E. School Books and Resources
1117 E. Devonshire Avenue, Phoenix, AZ 85014 602-277-3497 info@chsrc.org
Basic Membership $30 ___ Enhanced Membership $35 ___ Basic Member Upgrade $5 ___ New Renewal Renew Date ___
Last Name:________________________________ Husband: __________________________________
Last Name:________________________________ Wife: _____________________________________
Address: _________________________________ City: ____________________ State: ___ Zip _____
Home Phone: _________________ Cell Phone: ____________________ Work: ___________________
Email: ___________________________________ Fax: _______________________________________
Child 1: ______________________________ Birthdate: _____________________ Grade: ___________
Child 2: ______________________________ Birthdate: _____________________ Grade: ___________
Child 3: ______________________________ Birthdate: _____________________ Grade: ___________
Child 4: ______________________________ Birthdate: _____________________ Grade: ___________
Child 5: ______________________________ Birthdate: _____________________ Grade: ___________
I am interested in the following:
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Home School Legal Defense Association group membership through CHSRC
($115 Regular, $95 with group discount) Yes No Already member---Will transfer to CHSRC
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Resources for Special Needs: Yes No Specific issues: ____________________________________
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Volunteering with CHSRC: Yes No Specific areas: ______________________________________
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Support Groups: Yes No Already involved Which group(s): ________________________________
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Attending workshops to enhance my homeschooling skills: Yes No List subjects of interest:
__________________________________________________________________________________
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Questions or concerns I have: __________________________________________________________
__________________________________________________________________________________
I understand that membership entitles me to use of the rental library and classes, and discounts on various services. I/We agree
to return all class textbooks and all library materials checked out from Covenant on or before the designated end of semester
date in good condition. If my students disenroll from classes, class texts will be returned immediately. Late, lost, or damaged
materials will result in fines which will continue to accumulate until paid in full. If deposits have been made for library items,
these will be refunded when materials are returned on time and in good condition, or forfeited if these conditions are not met.
*Borrowers from outside Maricopa County will have deposits based on the value of the materials rented.
Please provide the following information for your Covenant library membership:
Driver’s License #: ____________________________ Expiration Date: ____________________
Social Security #: _______/_______/________ Date of Birth: ___________________________
Signature: ___________________________________ Date: ______________________
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Office use only: Patron Bar Code # __________ Lib Data Base _____ QB Data Base _____ Member Packet ____ Rolodex ___ Member file ____
Reg. Amount $30 $35 Date: ________________ Cash MO Paypal Check # ___________ Registrar Initials: ____ Comments
Payment may be made in the following ways:
CASH DISCOUNT PRICE for cash, check, MO or Paypal Direct:
Ø Cash, Check or Money order: Covenant 1117 E.Devonshire Ave, Phoenix, AZ 85014
Ø By PayPal direct transfer from Paypal or bank account: (this account does not take credit or debit)
Go to www.paypal.com and send funds to hsgrd@cox.net
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Printer Friendly Group Membership Form
H.O.M.E SCHOOL BOOKS AND RESOURCES
1117 E. Devonshire Ave, Phoenix, AZ 85014 602-277-3497
info@chsrc.org www.homeschooresorucecenter.org
Basic Group Membership Form
For homeschool co-ops or private school groups desiring to use the HSBR lending library for group classes,
or to get the best discount rates on group book orders.
 | $50 annual membership fee for groups with 5 to 10 families
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| $5.00 per additional family
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| Up to three designated contacts who are responsible for placing and picking up orders and returning borrowed materials.
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| Primary purpose is for acquiring books for a group class by rental or purchase
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| Book rentals are $2 per semester for student books and $5 per semester for teacher books. |
| Additional personal book rentals are available to group members with an upgrade to a family membership to HSBR. |
| Purchases of books for co-op/group classes receive our best discount! |
| Additional personal book purchases will receive our everyday discount prices.
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| Group book rentals and purchases may be mailed to a single address for the contact person if the shipping costs are paid.
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| Class enrollment is not included in the group membership. Each family must upgrade to an enhanced family membership
to enroll in CHSRC classes by paying the difference from the group amount paid
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| Member discount rates are available for testing services (IOWA, Stanford, PSAT), transcript preparation and workshops.
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| Membership is good for 12 months from start date. |
| See HSBR book discount ordering chart for group rates on purchases. |
Date: ___________ New Group ______ Renewal Group_____ Renewal date__________
Group Name:__________________________________Contact:_____________________________
Mailing address: _____________________________ City ___________ State __ Zip_____
Contact Person Phone: _______________ Cell Phone:______________ Email: _________________
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Group Classes for which multiple texts are needed:
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Class member last names
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See below for additional classes and group members.
We agree to use the privilege of the HSBR Group Membership with care for the purpose intended. If additional families join our group with the purpose of getting the HSBR group benefits, their contact info and $5 per family will be forwarded to HSBR. All rental items will be returned by due date in good condition or late
and/or replacement fees will be assessed.
Designated Group Contact ______________________ Date ____________________
See belowfor payment information.******************************************************************************************************************************
Basic Group Membership Form—Page 2
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Additional Group Classes for which multiple texts are needed:
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Additional copies of this form may be made as needed.
When ordering books or materials, an order form will need to be completed with the payment in full in one transaction (i.e. organization or personal check etc.)
Payment may be made in the following ways:
CASH DISCOUNT PRICE for cash, check, MO or Paypal Direct:
Ø Cash, Check or Money order: Covenant 1117 E.Devonshire Ave, Phoenix, AZ 85014
Ø By PayPal direct transfer from Paypal or bank account: (this account does not take credit or debit)
Go to www.paypal.com and send funds to hsgrd@cox.net
Payment: 5- 10 families = $50.00 +___ additional families x $5 = _____ TOTAL: ________
A member of our staff will contact you regarding your order and an invoice will be sent. Thank you.
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Office Use Only: Date rec’d _________ Cash MO Paypal Ch # ________ Comments:
Books ordered: _______ Date ______ Books in _____ Date _________ Group contacted _____ Books picked up ______
7/05
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PAYMENT OPTIONS
Payment may be made in the following ways:
CASH DISCOUNT PRICE for cash, check, MO or Paypal Direct:
Ø Cash, Check or Money order: Covenant 1117 E.Devonshire Ave, Phoenix, AZ 85014
Ø By PayPal direct transfer from Paypal or bank account:
(this account does not take credit or debit)
Go to www.paypal.com and send funds to hsgrd@cox.net
If you need to pay by credit or debit, please contact us for instructions. These payments will not receive the cash discount price.
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