September 2017 Sign-up Form

This form is for the classes that start the week of September 4, 2017.

Student's name and age or grade (or Students' names and ages or grades):
If the student is an adult, just write "adult" instead of the age.
If there is more than one student and they are taking different classes, also include the courses each one will be taking.

Total number of students:


Parent's name (or your name if the student is an adult):
First Last

Address (you only need to put down the city and state):

Your E-mail address:
If the student has his own e-mail address, be sure to give your e-mail address here and not the student's.

2 Optional questions:

What kind of Internet connection do you have?
Dial-up modem
Broadband (cable, dsl, fiber)
Not sure

Where did you find out about the classes here?


Check the course(s) you want to use:


Early Church/Dark Ages History
Logic
Medieval History
Religion: The Mass
African/Pacific Geography
Math: Fractions
Ancient History
Bible History
U.S. History
Pennsylvania History
Science History
Science Projects
European & Asian Geography
American Geography (N. & S. America)
Church Latin
(Biblical) Greek grammar
Music theory

Creative Writing

     Number of children taking Creative Writing:

10-week courses:

Greek Alphabet
Hebrew Alphabet
Art Projects
Religion:Compline
Poetry
Science:Internet


Amount due for the first half of the year: $.00
Amount due for the full year: $.00

Coupon code: Click to Submit Coupon


No, it has not been sent yet.

By check/money order: Check number
By Credit Card/eCheck/Paypal

Check must be made payable to Kepharts LPH Resource Center or Richard Kephart.

Money Order payable to Richard Kephart.

Amount being paid for the classes that start in September: $.00
Payment is due when this form is sent.

Make sure you do not send this form more than once.

Write to me at rmkrc lphrc.org if you have any trouble with this form.


Privacy policy: This is for my record-keeping. No information collected here will ever be sold or given to any third party.