This is what I came up with so far. Thanks for all of your great suggestions!
Yours is really cute! Mine is simple and to the point. I guess I should have been more creative and added a graphic or two! I guess I'll go do that, too! Thanks for the inspiration!
I used the one on Teacher Tools and adapted it for my specific needs. I fit four to a page. My students are starting to use it and I've realized that several of them have told me "I did it, but I left it at home," so that's a change I will be making on the forms.
It's posted here on ProTeacher. The good thing about these MS Word downloads is that we can change them to suit our particular needs. If someone finds that it's something you can use, you can make it fit your own homework requirements.
Missing Homework Slip-4 to a page