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Himilo Community Connect - Homework Club
Student Registration Form
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Day Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Time Available
Your answer
Date Of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Other:
Clear selection
Name Of School
Your answer
Year Level
Prep
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Clear selection
Language spoken at home
*
English
Arabic
Somali
Other:
Required
Reason for joining the homework club program.
Your answer
How did you find out about the homework club program?
Friend
Family
Flyer
Case worker e.g. MOSS
What subjects does the student need help with?
English
Maths
Science
Physics
History
Reading
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