Homework Club Interest Form

Student Name/Nombre del estudiante

First NameLast Name

Student Birthday/Cumpleaños del estudiante

Date

Student's grade/Calificación del estudiante

Does your child have an IEP?/Su hijo tiene un IEP?

YesNo

Student's School/Escuela del Estudiante

Student's Parent Name/Nombre de los padres del estudiante

First NameLast Name

You are signing your child to to participate in our Homework Club?/Está inscribiendo a su hijo para participar en nuestro Club de Tareas

YesNo

You acknowledge that our Homework Club..

Is offered on Mondays beginning October 7Takes place from 3 p.m. - 4:30 p.m.Includes help with homeworkIncludes a snackIncludes a story (oftentimes based on the Bible)

Home Address/Dirección de la casa

Parent phone/Teléfono de los padres

Please enter a valid phone number.

Parent's Email/Correo electrónico de los padres

example@example.com

Emergency Contact Name/Nombre del contacto de emergencia

First NameLast Name

Emergency Contact phone/Teléfono de contacto de emergencia

Please enter a valid phone number.

Please tell us anything we should know to serve your child best/Por favor, díganos cualquier cosa que debamos saber para servir mejor a su hijo.

Thank you for your interest in our Homework Club!! Whether this is the beginning or the continuation of our relationship we are DELIGHTED to engage with you about the Club and look forward to serving your children well. Please correct any questions related to this program to admin@metamorphosiscommunity.org.

If you have food security needs text - Thrives - to (844) 696-0818 for direct text alerts if food distribution events.