BMC Elementary Application 2017, Summer Program
Last Name
Your answer
First Name
Your answer
Grade Entering Fall 2017
Tell us why you would like to enroll your child into the program. Please describe your child’s background / classes and math achievements (if any) in the space below.
Your answer
Have you ever taken "Math Kangaroo"? IF YES, what year?
Your answer
Gender (For statistical purposes only)
Parent 1 email
Your answer
Parent 2 email
Your answer
Parent 1 Name
Your answer
Parent 2 Name
Your answer
Parent 1 Phone
Your answer
Parent 2 Phone
Your answer
Out-of-State Emergency Contact (Name and phone)
Your answer
Does your child have serious medical conditions? If Yes, please specify in the next section
If you answered "Yes" in the previous section, please list here any serious medical conditions of your child
Your answer
Student's Address (Street/City/State/Zip Code)
Your answer
School, Name, Address
Your answer
What kind of school do you go to?
Preferred Name
Your answer
What race/ethnicity do you most identify with?
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