Affidavit - Pennsylvania Home Education Network - phen 2026

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Click ‘Get Form’ to open the Affidavit in the editor.
Begin by entering the Supervisor's Name and Telephone number of the home education site in the designated fields.
Fill in the Address, City, State, and Zip code of the home education site accurately.
Input the Child’s Name and Age. If there are multiple children, repeat this step for each child.
Review the certification statements regarding educational objectives, immunization status, and compliance with Act 169. Ensure all necessary information is provided.
Complete the section confirming that neither you nor any adults in the home have been convicted of specified criminal offenses within five years.
Sign and date the affidavit where indicated. Ensure that a notary public witnesses your signature for validation.

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