Register for Summer Math Preparation Programs

Student Information

Student Full Name

School

Birthday

Grade

Programs Previously Attended

Courses student has completed:

Does the student require any special accommodations to participate in the program?

Does your child have any allergies/intolerance to food, medication, or any other substances?

Parent Information

Parent Full Name

Parent Email

Parent Phone Number

Parent 2 Full Name

Parent 2 Email

Parent 2 Phone Number

Address

City

State

Zip Code

3. Emergency Contact Information

Emergency Contact Full Name

Emergency Contact Relationship

Emergency Contact Phone Number

Primary Doctor's Full Name

Primary Doctor's Phone Number

4. Additional Information

Authorized Person for Pickup (note: in addition to parents and emergency contacts)

How did you hear of us?

6. Acknowledgement of Terms

Random Math Camp is a fee-for-service program based on confirmed enrollments and secured deposits. In order to reserve your child(ren)’s spot, full payment must be received for each child and session you are registering for. Student(s) would need to take an assessment before placement can be confirmed.
I HAVE CAREFULLY READ THE RANDOM MATH CLASS POLICIES. MY SIGNATURE BELOW INDICATES COMPLIANCE WITH RANDOM MATH POLICIES. I SIGN IT FREELY AND VOLUNTARILY.
Parent or Guardian - You will be required to review and sign the registration form on the first day of the session.

Parent or Guardian Signature

DateI agree to receiving marketing and promotional materials.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Summer Courses 2024
Registration Form

Contact us at helpdesk@randommath.com for any questions.

Student Information

Parent Information

3. Emergency Contact Information

4. Additional Information

Class Selection

Foundational Courses

Intermediate Courses

Advanced Courses

6. Acknowledgement of Terms

Summer Courses 2024Registration Form

Contact us at helpdesk@randommath.com for any questions.

Student Information

Parent Information

3. Emergency Contact Information

4. Additional Information

Class Selection

Foundational Courses

Intermediate Courses

Advanced Courses

6. Acknowledgement of Terms

Summer Courses 2024
Registration Form