Homework Club Registration
Name:_________________________
Grade:_________________________
TA:____________________________

Days of week to attend Homework Club
(circle)
Monday---Tuesday---Wednesday---Thursday

Parent Name:_________________________
Phone Number (h):___________________
                          (w):__________________
                          (c):__________________

Please write any specific plans or guidelines for us to keep in mind
while your son or daughter is with us in Homework Club.
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________________________________________________
________________________________________________
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Signature:________________________________Date:__________