Homework Club Signup
This form registers your child(ren) for the after school Homework Club at Cincinnati Urban Promise. This club meets on Tuesday and Thursday afternoons beginning January 14th from 3:00pm-5:30pm. Students can stay onsite from 5:30-6:30pm for dinner, please indicate if your child will stay for dinner below. All students receive a health snack, time to do homework, help with home work as needed, and other fun activities throughout the year.
Parent Full Name *
Your answer
Email
Your answer
Address *
Your answer
Phone number *
Your answer
Student #1 Full Name: *
Your answer
Student #1 Birthday: *
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Student #1 Grade *
Student #2 Full Name:
Your answer
Student #2 Birthday:
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YYYY
Student #2 Grade
Does your child intend to stay for dinner?
Does your child have any allergies? *
What are your child's allergies?
Your answer
By checking yes you agree that your child will abide by all CUP youth program rules and behavior expectations and that if your child does not abide by these standards that your child will be asked to sit out for one week, and if the behavior continues your child will be asked to leave the program *
Required
By checking yes you acknowledge that CUP is not responsible for lost or stolen items while your child is at CUP programming. *
Required
By checking yes you agree to hold CUP blameless for all injury or accident that may occur due to participation in CUP programming and agree to allow CUP Staff to provide emergency care for your child(ren) in case of emergency. *
Required
I understand that CUP does not provide transportation for the Homework Club and that my child may only receive transportation if my child is enrolled in the CUP mentoring program. All Homework Club participants may walk, be picked up and dropped off by a parent or take other forms of transportation as allowed by the parent. *
Required
My child will be: *
Full Name of Person picking up and dropping of my child: (please include contact information)
Your answer
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