TAMU Math Circle 2016-17 Registration
Welcome to the TAMU Math Circle for the 2015-16 Academic year.
There are 3 steps to registering. It is all done online. If you can't
register online, please come to the first meeting and do it there.

1) A parent or guardian must fill out this Registration Form.
If you have several children, please fill out a separate form for each child.

2) Please print the required University's Liability Waiver Form which is available at
     http://mathcircle.tamu.edu/wp-content/uploads/2016/09/WaiverForm2016.pdf
Please sign it and bring it to the first meeting.
We will also have copies available at the first meeting for you to sign.

3) The regular registration fee is $100 for the year. This is used to pay for supplies, travel expenses for guest speakers, snacks, and rewards for our undergraduate and graduate student volunteers. If you can afford to pay more, we would greatly appreciate an additional contribution.

If the registration fee is in any way a hardship, (child on school lunch plan, multiple children attending, parents are grad students, etc.) please talk to
       Philip Yasskin <yasskin@tamu.edu> 979-574-1697 or
       Alex Sprintson <spalex@tamu.edu> 979-458-0092
about waiving or reducing or delaying fees. You will be given a Promotional Code to enter on page 5 of the Payment Form.

Payments may be made by credit card at the TAMU MarketPlace operated by TouchNet at
      https://secure.touchnet.com/C21490_ustores/web/store_main.jsp?STOREID=407
or by check payable to Texas A&M University by bringing it to the first meeting.
This covers the (regular, reduced or waived) registration fee and extra donations.

Note 1: On page 4 of the MarketPlace, (the Checkout page) you do not need to login or register. Just enter your email (again) and click on Continue Unregistered.
Note 2: Please fill out the TAMU MarketPlace form even if your fees have been waived. You will not see the reduction in the fee until you reach page 5 of the MarketPlace (the Payment page) where you will enter the reduced fee Promotional Code.

We are looking forward to seeing you and your child at the Math Circle.
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Student's First Name *
Student's Last Name: *
Student's Date of Birth *
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Grade Level: *
Please enter the student's grade for 2016-2017
School *
Please select which school the student is currently attending:
Current Math Teacher: *
Please enter the last name of the student's current math teacher at school or type Homeschooled.
Last math course completed *
Please select what math course the student last completed.
Group *
Please enter which group the student belongs in:
Do you plan to attend a problem solving session from 2 to 3?
This will be entirely optional and free of charge.
Clear selection
Student's Address *
Student E-Mail (Optional)
1st Parent or Guardian's Name *
Please enter the first and the last name of the student's 1st guardian.
1st Parent or Guardian's Email (If none, say None.) *
Please enter the preferred email address.
1st Parent or Guardian's Phone(s) *
Next to each, please indicate (H) Home, (W) Work, (C) Cell, (D) Day and/or (E) Evening.
2nd Parent or Guardian's Name (Optional)
Please enter the first and the last name of the student's 1st guardian.
2nd Parent or Guardian's Email (Optional)
Please enter the preferred email address.
2nd Parent or Guardian's Phone(s) (Optional)
Next to each, please indicate (H) Home, (W) Work, (C) Cell, (D) Day and/or (E) Evening.
Pick-Up People
Normally you will pick your child up at 5:00 p.m. in Blocker 220. List the names of all additional people who have permission to pick up your child.
Leave on Own Recognizance *
My child has my permission to leave the TAMU Math Circle program at 5:00 PM without adult supervision. (e.g. I work on campus, and my child may walk to my building.) THIS IS ONLY PERMITTED FOR CHILDREN WHO ARE 15 OR OLDER OR IN HIGH SCHOOL.
Emergency Contact *
This should be different from the parents or guardians listed above.
Emergency Contact's Relationship to Student *
Emergency Contact's Phone(s) *
Please enter the phone numbers that are appropriate during the Math Circle hours.
Medical Insurance Company
if the participant has medical insurance
Medical Insurance Policy Number
if the participant has medical insurance
Name of Primary Medical Insurance Policy Holder
if the participant has medical insurance
Health Concerns *
Please list any health concerns, including allergies, that may impact the student's experience at the Math Circle.
Parental Consent (Please read carefully) *
By checking below, as the (parent/guardian), I certify that my child has my permission to participate in the TAMU Math Circle program. I understand that s/he will be subject to the regulations of Texas A&M University, the Department of Mathematics and the TAMU Math Circle program. I understand that should a health emergency arise, I will be notified, but that if I cannot be reached by telephone, such medical treatment as deemed by competent medical personnel is authorized. The Math Department has my permission to post my child's projects and his/her photo identified by only first name and last initial on the TAMU Math Circle web site:  http://mathcircle.tamu.edu/ and in promotional materials.  The Math Department has my permission to include my child's name and my name, address, phone number and email address on a participant list for the TAMU Math Circle to be distributed only to other participants (possibly for car-pooling).
Parent or Legal Guardian's Name *
By typing my name here I agree to all the items above to which I have clicked Yes or I agree.
Today's Date *
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Further Comments
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