Homework club:
Quiet, focused, class with a teacher to help with
specific subjects as needed.
Grade: 1st –6th (Mrs. Guthrie)
Day: Tues. and Thurs. (Mrs. Guthrie’s
class room)
Time: 3:15— 4:30pm
Date: Oct. 2nd—Jan. 31st ( no class half
days or holidays)
Fee: Only $20.00 per session
(Scholarships
available)
2007-8 Student Registration Form
Student Name:___________________________________________________________
Students current teacher:__________________________________________________
Parent/Guardian Name:____________________________________________________
Address___________________________________________________
Daytime Phone_______________________ Evening Phone______________________
Cell Phone____________________________
E-mail Address__________________________________________
Emergency contact ______________________________________________________
I agree to provide a snack for my child.
My child can not leave before 4:30 unless prior arrangement. I will pick up my child at 4:30 prompt. Child may be dismissed from the class if
parent is late to pick up child and parent will be charged accordingly for
teachers time. Teacher has a right to
dismiss a child for discipline reasons.
Please make check payable to Thoreau PTA.
Turn forms into office or students teacher.
Payment due on or before Oct 2nd.
I have read and understand the above statements and give permission for my
child to participate in the after school study club.
Signature __________________________________________ Date:_______________
Questions?? Polly Blanchard 820-8909 or