Homework Assistance Application

Base Prices

The program hours are from 2:20 to 6:00 PM.

Days per Week	Monthly Price	Semester Price
5 Days	$430	$1634
4 Days	$385	$1463
3 Days	$335	$1273
2 Days	$275	$1045
1 Day	$200	$760

Discounts

KidzHOME Discount: Students who participate in other KidzHOME programs get a 5% discount from the base price of those programs.
Sibling Discount: Oldest child pays full price, while each additional child receives $25 off per month.
Find a Friend Discount: Get $20 off the next month for referring a new student

There is also a separate registration fee. For more info please click here. For the full list of prices please click here. Please fill out the application below:

KIDZHOME HW Assistance Application

First Child Information

Child's First Name *
Child's Last Name *
Preferred Name
Date of birth *mm/dd/yy
School and Grade *
Classroom and/or Class Number *If not yet known, please indicate, and let us know at the first opportunity
Food Allergies
Please specify

Second Child Information

Child's First Name
Child's Last Name
Preferred Name
Date of birth mm/dd/yy
School and Grade
Classroom and/or Class Number If not yet known, please indicate, and let us know at the first opportunity
Food Allergies
Please specify

Parent/Guardian Information

Parents/Guardians' Names *
Parents/Guardians' Email *
Parents/Guardians' Cellphone *
Parents/Guardians' Other Phone *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Emergency Contact *
Name and contact information in case of emergency
Persons Authorized to Pick Up Child *
Name, contact information. and relation to child

Parents/Guardians' Employment

Employment Name *
Occupation *
Work Phone *

Program Information

Please select a school for pick-up *
if you selected "Other" above, please specify
Please select the days of the week you need HW Assistance *
Please select if your child is already our student in another KIDZHOME program
This is important for calculating discounts.Russian Theater StudioOther KIDZHOME program
If you selected Other KIDZHOME program above, please specify
Payment Method *
How did you learn about us?
Comments
Important information about your child that we should know. All information will be kept strictly confidential.
Signature *By signing this application I permit KidzHOME to take pictures/videos of my child(ren) and publish them on its websites and Facebook page, as well as in its publicity materials.

Verification

Please enter any two digits *Example: 12
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