Math POT Registration Form 2026                        
(Note: Please do not fill out this form until you make the final decision and ready to make payment. There is no need to fill out this form for the free trial class.)
Sign in to Google to save your progress. Learn more
Untitled Title
Child Name *
Gender *
New Student ( Please choose No if you are a return student) *
Math POT Level *
Required
Parent/Guardian Name *
Phone Number *
Email Address (must be a gmail account) *
Referred by (If your child is a new student, not a return student, please fill out this section.)  Please make sure to find out the correct name of your friend's child name and POT level, otherwise it's hard to match who referred you. Thank you!
Terms of Agreement
I understand that it is my responsibility to pick up my child from the classroom at the time shown on the schedule.


I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.  

I understand that the Math POT will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.


I understand that after the homework is graded by the teacher, my child needs to correct the mistakes and it is my responsibility to check using the answer keys provided.


I understand that the Math POT is not responsible for lost or damaged personal property. All scheduled events and policies are subject to change. Children's’ homework, photos and quotes may be used for publicity purposes.


I accept the above Terms of Agreement *
Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.