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5th Grade Math Club
Mrs. Lauer and Mrs. Staples are so excited to have you join them for Math Club. You will have opportunities to challenge yourself and improve your mathematical thinking skills over the next 8 weeks.
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Student First Name
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Student Last Name
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Classroom Teacher's Name
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Parent's Email Address
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Home Address
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City
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State
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Zip Code
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Home Phone (XXX-XXX-XXXX)
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Emergency Contact (First and Last Name)
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Emergency Contact Cell Phone Number (XXX-XXX-XXXX)
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Parents are asked to arrive 5 minutes prior to class ending. No child will be allowed to walk home due to class being offered in winter months.
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Please list names of those authorized to pick up your child.
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T-Shirt Size
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Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
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Allergies (If none, list "NA")
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Payment of $40 will be paid as follows:
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PaySchools
Check (Payable to DGF School, dropped off in the Glyndon-Felton Elementary office and enveloped addressed to “Community Education”)
Cash (Dropped off in Community Education Office)
Financial Scholarship Requested
If requesting financial scholarship, note below how much you can afford to pay. If not requesting scholarship, note "NA"
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Partial Scholarship (note amount you can pay in "other" box below)
Full Scholarship
Other:
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My child has my permission to participate in the 2015 DGF Math Club. I, the undersigned, will assume responsibility in case of accidents, injury or lost or damaged personal items during the program’s duration.
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I give/do not give permission for photos or videotapes of my child to be reproduced for DGF Math Club promotional or educational purposes.
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