Chapel Hill Math Circle: Student Registration
Use this form to register as a participant in the Chapel Hill Math Circle for the Fall 2019 / Spring 2020 academic year. Students who participated during the previous year still need to re-register. The program will run from September 14, 2019 through the end of April 2020. If the program is full when you register, you will be placed on a wait list and notified when space is available.
Last Name of Student *
First Name of Student *
Birthdate *
Required by UNC
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Gender
Clear selection
Grade in 2019/2020 *
Which circle do you plan to attend?
Mobius Noodles is recommended for kindergarteners and first graders and their families. The Beginners Group is recommended for students in grades 1 - 3, the Elementary Group is recommended for students in grades 4 and 5, and some 3rd graders. The Intermediate Group is recommended for students in grades 6 - 8. The Advanced Group is recommended for students in grades 9 - 12. Exceptions may be made at the discretion of the director.
Clear selection
Current Math Class *
For example, 3rd grade math, or Pre-Algebra, or Math 1. If registering during the summer, please put down the math class you expect to take next year. This information is especially useful for students who wish to attend a group that is more advanced than their grade level.
Name of School
Did you participate in the Chapel Hill Math Circle in Fall 2018 and / or Spring 2019? *
First Name of Parent / Guardian #1 *
Last Name of Parent / Guardian #1 *
Email Address of Parent / Guardian #1 *
Information about the program will be sent to this email address.
Relationship to Student
E.g. mother or father
First Name of Parent / Guardian #2
Optional
Last Name of Parent / Guardian #2
Optional
Email Address of Parent / Guardian #2
Optional. If an email address is entered here, information about the program will also be sent to this email address.
Relationship to Student
Optional. E.g. mother or father
Name of emergency contact (parent / guardian / other responsible adult) *
In the unlikely event that we need to reach you during or immediately after the math circle.
Phone number of emergency contact (parent / guardian / other responsible adult) *
In the unlikely event that we need to reach you during or immediately after the math circle.
Address of emergency contact (parent / guardian / other responsible adult) *
This is required by UNC.
Email Address of Student
Optional. If an email address is entered here, information about the program will be sent to this address. Information will also be sent to the parent email address(es) entered.
Parent Consent: I give permission to use pictures that include my child on the website. *
Please ask a parent or guardian to fill this out.
Comments
Please mention how you found out about the Chapel Hill Math Circle and any other information you'd like the directors to know.
Vaccination record: please list the dates of past immunizations for DTP / DTaP/ DT *
Vaccination record: please list the dates of past immunizations for dT/TdaP *
For children 12 years or older
Vaccination record: please list the dates of past immunizations for Polio (IPV/OPV) *
Vaccination record: please list the dates of past immunizations for Hib *
Vaccination record: please list the dates of past immunizations for Hepatitis B *
Vaccination record: please list the dates of past immunizations for MMR (combined doses) *
Vaccination record: please list the dates of past immunizations for Chicken Pox *
Vaccination record: please list the dates of past immunizations for Meningococcal *
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