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About Us
Academic Year
Summer Hub
Test Prep Hub
Homeschool Hub
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- Driver's Ed Program
College Hub
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- Parent Hub Programs
- Parent Hub Workshops
Microschool
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Enroll
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The Learning Pod Post Acceptance Registration Form

The Learning Pod Post Acceptance Registration Form

For accepted Students and their Families

Before you begin: Complete this form only after receiving written acceptance. Registration is complete when Homework Hub confirms receipt of this form, all required agreements and records, and the required initial payment.

Homework Hub Registration Form

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1. Accepted Student & Enrollment Details

Please use the student's legal name where requested and confirm the placement stated in the acceptance letter.

STUDENT'S LEGAL NAME:

PREFERRED NAME:

DATE OF BIRTH:

SCHOOL YEAR

ACCEPTED START DATE:

GRADE LEVEL REPORTED TO PROGRAM:

Accepted division (check one):

Primary

Intermediate

Secondary

Confirm the specific program you are enrolling in:

Primary/Intermediate Direct Instruction - 3 required days

Primary/Intermediate Project-Based Learning - 2 optional days

Secondary Math/Science Direct Instruction - 2 days

Secondary ELA/History Direct Instruction - 2 days

AM Supplemental Learning Pod

PM Supplemental Learning Pod

Membership term (check one; payment amounts and due dates appear in the separate Membership Agreement):

2.5-month membership

5-month membership

10-month membership

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2. Parent, Guardian & Household Information

Complete both guardian sections when applicable. Indicate who should receive academic, billing, and emergency communications.

PARENT/GUARDIAN 1 - FULL NAME:

RELATIONSHIP TO STUDENT:

EMAIL:

PRIMARY PHONE:

HOME ADDRESS:

CITY / STATE / ZIP:

PARENT/GUARDIAN 2 - FULL NAME:

RELATIONSHIP TO STUDENT:

EMAIL:

PRIMARY PHONE:

ADDRESS, IF DIFFERENT:

CITY / STATE / ZIP:

Communication preferences:

Guardian 1 is the primary academic contact

Guardian 2 is the primary academic contact

Send academic communications to both

Guardian 1 is the billing contact

Guardian 2 is the billing contact

Send billing communications to both

CUSTODY ARRANGEMENTS, COURT ORDERS, OR COMMUNICATION RESTRICTIONS HOMEWORK HUB MUST FOLLOW:

Attach current supporting documents when applicable.

Upload File

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3. Homeschool Coordination & Records

This information supports scheduling, academic planning, record organization, and coordination with the family's homeschool plan.

Have you already submitted a Letter of Intent and/or IHIP? If so, do you know the date it was submitted?

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Unsure? That’s fine! Our homeschool expert will complete this with you!

Support requested at registration (included in package):

I would like help organizing homeschool records and deadlines

I would like to discuss curriculum planning or modifications

I would like to discuss district communication support

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Family responsibility: Homework Hub provides educational support. Parents and persons in parental relation remain responsible for meeting applicable New York homeschool requirements. Homeschool advising and compliance services are independently provided by My Homeschool Expert™.

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4. Emergency Contacts & Authorized Release

List adults who may be contacted if a parent or guardian cannot be reached. Authorized adults may be asked to show photo identification.

EMERGENCY CONTACT 1 - FULL NAME:

RELATIONSHIP TO STUDENT:

PRIMARY PHONE:

ALTERNATE PHONE:

EMERGENCY CONTACT 2 - FULL NAME:

RELATIONSHIP TO STUDENT:

PRIMARY PHONE:

ALTERNATE PHONE:

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Authorized Pickup and Release List

In addition to the parents/guardians listed above, the student may be released to the following adults:

AUTHORIZED ADULT 1:

RELATIONSHIP:

PHONE:

PHOTO ID/NOTES:

Upload File

AUTHORIZED ADULT 2:

RELATIONSHIP:

PHONE:

PHOTO ID/NOTES:

Upload File

AUTHORIZED ADULT 3:

RELATIONSHIP:

PHONE:

PHOTO ID/NOTES:

Upload File

Usual dismissal arrangement:

Parent/guardian pickup

Authorized adult pickup

Approved transportation arrangement

Other arrangement described below

TRANSPORTATION OR DISMISSAL INSTRUCTIONS

INDIVIDUALS WHO MAY NOT PICK UP THE STUDENT Homework Hub may request legal documentation when restrictions apply.

May the student leave independently at dismissal? (Secondary students only; separate written approval may be required.)

Yes - Homework Hub has received the required written approval

Not applicable

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5. Health, Safety & Participation Information

Share only information needed to support safe participation during the program day. Notify Homework Hub promptly if any information changes.

ALLERGIES, INCLUDING FOOD, MEDICATION, ENVIRONMENTAL, OR INSECT ALLERGIES:

MEDICAL CONDITIONS OR HEALTH CONCERNS RELEVANT TO PARTICIPATION OR EMERGENCY RESPONSE:

DIETARY, SENSORY, COMMUNICATION, MOBILITY, OR OTHER PARTICIPATION NEEDS:

SIGNS, TRIGGERS, OR SYMPTOMS STAFF SHOULD RECOGNIZE AND THE RESPONSE THAT IS HELPFUL:

Medication and emergency action plans:

No medication or emergency action plan is needed during program hours

The student may need medication or an emergency action plan

Homework Hub has received all required instructions and forms

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Important: If medication, an allergy plan, or another emergency action plan is needed, Homework Hub will identify any additional forms or written instructions required before the student's first day.

PHYSICIAN / PRACTICE NAME:

PHYSICIAN PHONE:

PREFERRED HOSPITAL, IF ANY:

HEALTH INSURANCE CARRIER, OPTIONAL:

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Emergency Authorization

If a parent or guardian cannot be reached in an emergency, I authorize Homework Hub personnel to contact emergency services and to provide relevant information from this form to emergency responders. I authorize emergency evaluation and treatment reasonably considered necessary for the student's immediate safety. I understand that Homework Hub will attempt to contact the listed parents/guardians and that the family is responsible for costs charged by outside providers.

I authorize the emergency actions described above

PARENT/GUARDIAN INITIALS:

DATE:

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6. Participation & Communication Permissions

Complete each subsection and check all options that apply unless the subsection says otherwise. A parent or guardian may change a permission selection by submitting a written request.

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Enter your free text here

Photography and Video (Check each permission you grant. Public use should be checked only if you authorize marketing use):

Yes - internal classroom documentation and private family updates

Yes - Homework Hub website, printed materials, advertising, and social media

No - do not photograph or record my student except for security or safety purposes

Student Work:

May be displayed or shared using the student's first name only

May be displayed or shared without the student's name

May be used only within the Learning Pod and private family communications

Technology and Digital Learning:

I authorize supervised use of age-appropriate internet resources and educational technology

Please contact me before creating any student-specific online account

I do not authorize student-specific online accounts

Field Trips and Off-Site Activities:

Please send me information about field trips and off-site activities

I do not wish to receive field-trip information at this time

Program Communications (Select permitted methods for essential program communications. These selections do not enroll you in marketing messages.)

Email for academic, schedule, billing, and safety-related program communications

TalkingPoints for time-sensitive schedule, closure, pickup, and safety notifications

Phone call when direct conversation is needed

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7. Family Agreements & Acknowledgments

Please check each statement after reviewing it. Separate documents may contain additional financial, attendance, withdrawal, privacy, and program policies.

I understand that the Learning Pod is a small, collaborative homeschool program and that consistent attendance, punctuality, respectful participation, and family communication are expected.

I understand that students are placed in Primary, Intermediate, or Secondary divisions and in instructional settings according to academic readiness, learning style, and support needs rather than age alone.

I understand that instructional grouping may include one-on-one instruction, groups of up to three students per teacher, or groups of up to six students per teacher, depending on student and instructional needs.

I understand that the Learning Pod complements the education provided at home and that the parent or person in parental relation remains responsible for the student's homeschool program and applicable New York requirements.

I understand that submission of information about learning supports does not guarantee that every requested service, accommodation, or modification can be provided within the Learning Pod model.

I agree to notify Homework Hub promptly of changes to contact information, custody arrangements, authorized pickup, health and safety needs, transportation, or other information relevant to participation.

I understand that tuition, payment dates, refunds or credits, withdrawal, and other financial obligations are governed by the separate signed Membership or Enrollment Agreement.

I certify that the information in this registration form is complete and accurate to the best of my knowledge.

Registration Checklist (Family and office may use this checklist to confirm required items):

Completed post-acceptance registration form

Payment authorization and required initial payment

Custody or court documents, if applicable

Signed Membership Enrollment Agreement

Emergency action plan or medication forms, if applicable

Any updated educational or support records requested by Homework Hub

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Parent / Guardian Certification

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By signing below, I confirm that I have authority to register the student and agree to the selections and acknowledgments in this form.

PRINTED NAME:

New Field:

DATE:

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Second Parent / Guardian, if applicable

PRINTED NAME:

RELATIONSHIP TO STUDENT:

SIGNATURE:

DATE:

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Student Acknowledgment, if developmentally appropriate

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I understand that I am joining a small learning community. I will participate, follow directions, treat others respectfully, care for materials, and ask for help when I need it.

STUDENT PRINTED NAME:

STUDENT SIGNATURE:

DATE:

PARENT/GUARDIAN INITIALS:

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8. Homework Hub Office Use Only

ACCEPTANCE VERIFIED BY:

DATE VERIFIED:

ASSIGNED DIVISION:

CONFIRMED START DATE:

MEMBERSHIP TERM:

PROGRAM / SCHEDULE CODE:

TUITION / MEMBERSHIP AMOUNT:

PAYMENT SCHEDULE:

INITIAL PAYMENT RECEIVED:

New Field:

AGREEMENT RECEIVED:

EMERGENCY/HEALTH FORMS COMPLETE:

PICKUP AUTHORIZATION COMPLETE:

PLACEMENT, SCHEDULING, OR IMPLEMENTATION NOTES:

Field label

Registration complete

Registration pending items listed below

PENDING ITEMS AND DUE DATES:

STAFF NAME / INITIALS:

COMPLETION DATE:

Thank you for submitting your Admissions Application!

~Homework Hub

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