The Homework Club - Parent Registration Form

If you have already spoken with our office and we have recorded a credit card number for you, than filling out this form and reading The Homework Club expectations and policies will conclude your child's registration process. If this is the first step in your registration process, after submitting this form, a representative from our office will call you to answer additional questions and to record your credit card number. Either way, this form must be filled out prior to your child's first Homework Club session. By submitting this form, you indicate that you completely filled out the form and that you have read and understood the expectations and policies of The Homework Club..

Note: If you have more than one child registered in The Homework Club, you must fill out a form for each child.

Note: All fields marked with a (*) are mandatory.

Contact Information

Student’s Full Name:	*

Name of Primary Parent Contact:	*
Phone Number:	*
Alternate Phone Number:	*
Primary Parent Email Address:	*
Street Address:	*
City:	*
Zip:	*

Name of Additional Parent Contact:	*
Phone Number:	*

Emergency Contact Name:	*
Relation:	*
Phone Number:	*

Medical Information

Doctor’s Name:	*
Doctor’s Phone:	*
Doctor’s Address:	*

Health Insurance Provider:	*
Policy #:	*

Does your child have any medical problems, allergies, special medications, etc. of which we should be aware? Please describe fully: *

Emergency Authorization
I hereby give permission for The Homework Club employee(s) in charge of my child’s tutoring group to procure emergency medical or dental treatment—including ambulance transportation and emergency room hospital admission—in case of injury or illness, if I cannot be reached. I also release The Homework Club from all liability in connection with emergency medical treatment.

Your Typed Name is Your Online Signature: *	Date: * (ie. mm/dd/yyyy)

New Student Tutoring Profile

Current grade in school:	*
Homework Club where student is enrolled:	*
Please check the days of the week that you would like your child enrolled (2 day minimum):	Mon Tue Wed Thu
Please indicate the date you would like your child to start The Homework Club:	*

Please indicate your child's academic grades (ex. A, B, C) in:
Language arts:	*
Math:	*
Social studies:	*
Science:	*
Note: By submitting this form you are authorizing us to work with the school to stay up to date with your child's grades.

Which two subjects (or areas) should we focus on with your child? If you would like to provide additional information on your child's needs, please feel free to use this space. You may include as much text as you wish.	*

Our daily progress reporting system updates interested parties on your child’s progress. The above Primary Parent Email Address will receive progress reports. Up to 4 other parties may also wish to receive reports (i.e. other family members, teachers, and counselors). Please list additional recipients below. Note: By listing these addresses, you are indicating that they have consented to receiving daily reports.

Email Address 1:
Name:
Relation:

Email Address 2:
Name:
Relation:

Email Address 3:
Name:
Relation:

Email Address 4:
Name:
Relation:

Help Us to Help Others As a non-profit, The Homework Club works hard to provide academic support to students, regardless of family income. Without cost to you, you can help us increase our scholarship funds. We have a partnership with eScrip. When you shop at eScrip merchants, they donate a percentage of your purchase to The Homework Club. This is the merchant’s donation—it does not cost you anything. With your permission, we will provide eScrip with your credit card number. They use this number to insure a percentage of your purchases is donated to our scholarship fund. You may click here for a list of participating merchants.

Yes, please enroll me in eScrip
No, please do not enroll me in eScrip

Homework Club Billing, Refund, and Cancellation Policies

The Homework Club is a month to month program. Minimum billing is one month’s session; Most students need at least one month to adapt to our program and begin to improve their skills.

Billing occurs, in advance, one time per month. You will receive an e-mailed invoice at least 2 days before your credit card is charged.

Sessions not previously billed are billed at this time.
Students are automatically enrolled for the next month.

To cancel or terminate, please call (800) 523-3550 or (415) 491-0142 before the end of the current month.: Please contact us before the last week of the current month if you wish to change your child’s schedule.

Fees

Middle School Locations:

$35 one time, non-refundable, registration fee.
$35 for 2 hour session at middle school sites – Available for middle school students.
$40 fee for declined credit cards.

Note: Homework Club fees are billed to your credit card. We do not accept cash or checks.

Refunds and Make-Up Days

Refunds are not given. Please make up all missed classes within the same billing month. If your student is ill and misses a session, or if you and your student have an important conflicting appointment, please claim a make up day. There’s no need to telephone or email – your child should simply attend an additional session. Make up days work on the honor system: please bear in mind that sport practices, social engagements, and nice weather are not acceptable reasons to miss sessions and claim make up days! If your child’s schedule changes permanently, please contact us so that we can arrange a new Homework Club schedule. Homework Club staffs for the expected number of students per day. It’s important for your student to keep his/her registered schedule so that all students receive sufficient personal attention. Students who arrive late will be charged for the entire session; punctuality is important to build time management skills.

Welcome to The Homework Club!
Information for New Families and Students

Better study habits are a matter of personal growth for students, and growth takes time. Psychologists know that the initial phase of forming a good new habit takes a minimum of 28 days. To make sure a good new habit becomes so deeply entrenched that it's second nature, people of all ages need at least six months. Our experience and research suggests the following timeline.

First 4 - 6 Weeks Students make new friends and develop a positive relationship with their tutors. They learn to keep daily planners up to date, share complete and accurate information about their assignments with tutors, keep their binders and backpacks neat and organized, and complete two or more homework assignments per session. Not all students will achieve these initial goals within the first 4-6 weeks, but all should show some progress.

Tutors will check your student's work for completeness and accuracy, and provide guidance on how to correct mistakes. Tutors will NOT do the homework for the students, sit next to them every minute, or correct every single mistake on every assignment. Instead, tutors will begin to empower your student to take charge of homework and to learn the art of successful study.
On days when your student completes homework assignments early, or when no homework is assigned, work will focus on enrichment activities from our Milestones Study Skills System. Students are also instructed to study ahead for tests, read ahead in textbooks, or work on upcoming projects. The goal is to help them become resourceful and proactive learners.

By the End of the First Trimester If all goes well, you and your student should notice a flow of better grades on homework assignments. Your student should become less tense about homework and should show some improvement in organizational skills. Many students find that their test grades begin to improve.

By the End of the School Year Daily homework assignments should no longer be an issue at home, and your student should be able to work more independently. Many students feel proud of their improved test scores and higher GPAs. All students should notice improvement and feel more at home in their school community.

What Happens at Homework Club?
Homework Club tutoring sessions are quite different from a normal school "study hall". Tutors don’t just wait for students to ask questions. Instead, they work proactively to:

Help students overcome organizational and time management issues,
Help students complete their two hardest assignments first,
Draw students into conversations about assignments to build comprehension,
Check homework for accuracy and neatness,
Teach students how to do their own corrections.

If your student has a lot of homework – or is still learning how to work efficiently – some assignments may be left to do at home. On days when students have no homework or when they finish early, tutors help with organizational skills and may assign extra practice in weak school subjects. Tutors prioritize any free time to achieve educational goals: some students are a bit startled to discover that coloring, random internet surfing, and comic books are not OK at Homework Club!

The Milestones Study Skills System
Homework Club teaches study skills through the medium of daily homework. Most students find that it takes a full academic year to complete this system. The long-term goal is to help each student become an independent, self-motivated “resourceful learner.” The daily progress reports you will receive by email will refer to your student’s growth through the Milestones curriculum. Here’s a thumbnail sketch of the four Milestones:

Milestone I – Organization

Student’s binder and backpack is neat and organized.
Student fills out daily planner accurately.
Student shares information with tutor about all assignments.
Student completes two hardest assignments at Homework Club.

Milestone II – "Favorite Mistakes"

Tutor helps student recognize “favorite mistakes” – habitual, unconscious goofs that contribute to low grades.
Tutor and student develop strategies to help student let go of favorite mistakes.
Strategies practiced through daily homework until favorite mistake dissolves.

Milestone III – The Big Picture

Tutor encourages student to verbalize the main ideas behind each assignment, and to see how assignments connect from week to week.
Tutor helps student strengthen basic academic skills and see how these support current assignments.

Milestone IV – Resourceful Learner

Tutor helps student through a long, complex, multi-stage assignment such as a social studies research paper.
Student exhibits an age-appropriate level of independence and organization.

Understanding Daily Progress Reports
You will receive an email daily progress report from the tutor who worked with your student that day. The report provides information at a glance on how your student performed academically and behaviorally, assignments completed, weekend assignments, and tutor feedback.

Tutors welcome your feedback, so please feel free to reply to the progress reports with comments, suggestions, or key information about your student’s needs.

Please understand that these daily progress reports are written quickly, from the tutor’s home computer at the end of a long day, and are not edited here at the office. Don’t worry about the periodic typo – these reports are a slice of life and come straight from the tutor’s heart. If you are not receiving daily progress reports, please telephone the office; sometimes computer glitches happen!

Thank you – we look forward to a happy and successful relationship!

Please print now, so that you will have a record of our policies and your expectations.