4th Grade Math Club

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

4th Grade Math Club - Dilworth

Who: Dilworth Students in 4th grade
What: DGF Math Club – Measurement Session
Where: Room #202, Dilworth Elementary
When: Six Mondays– September 19, 26, October 3, 10, 24 and November 7 - 3:10 p.m. to 5:00 p.m.
Fee: $40

This cost includes all materials, snacks and a very cool DGF Math Club t-shirt!

The DGF Math Club is offered through DGF Community Education and instructed by Ms. Spilde and Mrs. Klungtvedt.

Class is limited to 25 students. Registration is on a first come – first serve basis.

Student First Name *

Student Last Name *

Classroom Teacher's Name *

Parent's First and Last Name *

Parent's Email Address *

Home Address *

City *

State *

Zip Code *

Home Phone (XXX-XXX-XXXX) *

Emergency Contact (First and Last Name) *

Emergency Contact Cell Phone Number (XXX-XXX-XXXX) *

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. *

Please list names of those authorized to pick up your child.

T-Shirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Allergies (If none, list "NA") *

Payment of $40 will be paid as follows: *

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)

Tuition Assistance Requested

If requesting tuition assistance (TA), please check that below. If not requesting assistance, note "N/A". Tuition Assistance guidelines are as follows: (1) Students must be enrolled in DGF Schools. (2) Students must be on the free/reduced lunch program to qualify for TA. (3) TA requests must be submitted by September 16th on the registration form. No TA requests will be accepted after this date. (4) Parents will be notified via email by September 19th if their child was awarded TA. If parent doesn’t have an email address, parent needs to contact Community Education directly regarding TA request status. (4) If a child receives TA, remaining balance owed is due by September 22nd. *

Tuition Assistance Requested

N/A

Required

My child has my permission to participate in the 2016 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. *

I agree

I give/do not give permission for photos or videotapes of my child to be reproduced for DGF Math Club promotional or educational purposes. *

Give permission

Do not give permission

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Dilworth Glyndon Felton School District 2164. Report Abuse

Forms