PAGES of Hernando
(Partners Allied for Gifted Education and Support)
Committed to Serving the Families of the Gifted in Our Community

MEMBERSHIP APPLICATION
 While membership is free, this organization relies on donations to cover administrative costs. Donations of any size are greatly appreciated.

Note: Family dynamics are important! Please list all siblings. This form will accommodate two children. For more children, please submit additional applications as needed. If a child has not been identified as gifted or is not enrolled in the county's gifted program, please write "n/a" in the box asking for the gifted teacher's name.

(1) PARENT/GUARDIAN NAME (Last, First):
 
(2) PARENT/GUARDIAN NAME (Last, First):
 
MAILING ADDRESS (Street, City, Zip):
 
EMAIL ADDRESS:
 
 HOME PHONE NUMBER:
 
ALTERNATE PHONE #(S) (note work or cell or both):

PARENT/GUARDIAN OCCUPATIONS:
 
(1) CHILD'S NAME (Last, First):
 
(1) Child's Grade (2007-2008):       (1) Child's Birth date:

(1) Child's Home School & Teacher:
 
(1) Child's Gifted Teacher:
 
(1) Child's Hobbies & Interests:
 
(2) CHILD'S NAME (Last, First):
 
(2) Child's Grade (2007-2008):       (2) Child's Birth date: 

(2) Child's Home School & Teacher:
 
(2) Child's Gifted Teacher:
 
(2) Child's Hobbies & Interests:
 
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Questions, Comments, Concerns: