Long Island Test Prep Center for SAT, ACT, AP and Regents

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Home
About Us
Academic Year
Summer Hub
Test Prep Hub
- Test Prep Programs
- ISEE/SSAT
- CHSEE/TACHS
- Quarterlies
- Midterms
- Finals
- Foreign Language Checkpoints
- Regents
- AP
- IB
- ACT/SAT-ELITE
- GRE
- MCAT/DAT
- LSAT
- GED
College Hub
Driving Hub
- Driving Hub
Parent Hub
- Parent Workshops
  - Executive Functioning Adult Workshop
  - Mahjongg Workshop
Micro School
- HwH Academy
Enroll
Join Our Team
- Employment Opportunities
- Staff Forms
Blog

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Homework Hub Registration Form

Student's First Name:

Student's Last Name:

Gender:

M

F

Other

Today's Date:

Home Address:

City:

State:

Zip Code:

Date of Birth:

Grade:

Name of School:

School District:

Free Text

---------------------------------------------------------------------------------------------------------------------------------------------------

(Legal Guardian's) First Name:

(Legal Guardian's) Last Name:

Relationship to Child:

Cell Number:

Office Number:

Email Address:

Home Address (If different from above):

City:

State:

Zip Code:

Free Text

---------------------------------------------------------------------------------------------------------------------------------------------------

Are there any special needs or concerns we should know about?

Does your child have an IEP or 504?

Y

N

Free Text

If yes, please provide us with a copy (optional).

Does your child wear glasses?

Y

N

Does your child have allergies?

Y

N

Field label

Does your child receive medication (optional)?

Y

N

If I cannot pick up my child from Homework Hub, I give the following person permission (ID required). Full Name:

Relationship to Child:

Phone:

I give my child permission (grade 8-12 only) to leave the Homework Hub unattended after his/her session is completed.

Free Text

---------------------------------------------------------------------------------------------------------------------------------------------------

Free Text

Click here to read about Homework Hub's Office Policies

Opt-In

By checking, I agree to share my form

Free Text

responses.

Opt-In

By clicking SUBMIT, I acknowledge

Free Text

that I am the parent or legal guardian of the above student and all information in this form is true and correct.

Free Text

All information above is kept confidential by HwH

Thank you for submitting your Registration Form!

~Homework Hub

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