Bay Laurel Homework Club Registration Form
Thank you for your interest in Bay Laurel's Homework Club! To register your child for Homework Club, please complete the form below.

HOURS:
Remember, if school is open, WE ARE OPEN! Homework Club is open 5 days a week until 4:00PM.
--Mon/Tue/Thu/Fri: 3:00-4:00PM (price includes supervised care from 2:17-3:00PM for grades 1-3)
--Wednesdays: 1:30-2:30PM (price includes supervised care + lunch period from 12:36-1:30PM)
--After care option for Wednesdays: 2:30-4:00PM
--Homework Club hours are adjusted accordingly for Minimum Day Schedule

PRICING (per 4 week period):
--1 day/week = $100
--2 days/week = $125
--3 days/week = $150
--4 days/week = $175
--5 days/week = $200
--After Care (Wed. only) = +$60 to any option

QUESTIONS? Contact:
--Donna Ouaknine (805) 338-1967
--Debbie Dreiman (818) 277-8776

Email address *
SECTION 1: Student/Parent Info
Student's Name *
Your answer
Grade & Teacher *
Parent/Guardian Name *
Your answer
Home Address (incl. City/State/Zip) *
Your answer
Untitled Title
Please provide at least one phone number
Cell Phone # *
Your answer
Home Phone #
Your answer
Work Phone #
Your answer
My child will attend Homework Club on the following days: *
Required
I would like to add the extra 1.5 hours on Wednesdays, extending pick up time until 4:00PM *
Required
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