Kittitas Valley Math Circle Fall 2022 AMC 8 Prep Registration Form.
Thank you for your interest in registering for the Fall 2022 Kittitas Valley Math Circle AMC 8 Prep Sessions.

Please note the 2022 program dates include: Oct 24, Oct 31, Nov 7, Nov 14, Nov 21, Nov 28, Dec 5, and Dec 12.
The 2023 program dates include:January 9 and Jan 16 (via Zoom- link going to be sent to those registered) . 
The exam will be 3-4:40 on January 20th (Jan 23rd is the back up date in case of snow)

There are two parts to this student registration:
(1) Minor Participation Waiver  - Please review the program waiver and consent to your minor's participation in this activity.
(2) Student Registration - Please provide information about your youth.

If you have further questions about the KVMC program please feel free to contact us (COTS_Events@cwu.edu) or visit our website https://www.cwu.edu/math/kittitas-valley-math-circle
Sign in to Google to save your progress. Learn more
Student's First Name *
Student's Last Name *
Student's Preferred Mailing Address
Please read the KVMC minor waiver below:
I, the parent/legal guardian, provide permission for the minor listed above to participate in the Kittitas Valley Math Circle, to begin in October 2022, organized by Central Washington University and hosted in the Samuelson building of the Central Washington University campus.

I consent to minor’s participation in the activity and acknowledge that I fully understand minor’s participation may involve risk of serious injury, illness, or death, including losses which may result not only from minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the activity is being conducted, and/or the rules of play of this type of activity.  

I understand that if I have any risk concerns, I shall discuss them completely with the Activity Contact before I sign this agreement and before minor’s participation in the activity begins.  
The Activity Contact is Dr. Brandy Wiegers, 530-220-0324, brandy.wiegers@cwu.edu.
The CWU College of Science Outreach Activity Contact is Dannica Price, 509-963-2135, COTS_events@cwu.edu.

Knowing and understanding the risks involved with participation in the activity, I hereby voluntarily and willingly assume full and complete responsibility for all losses and damages, including injury, illness, and death, resulting from minor’s participation in the activity, including transportation to and from the activity.  I agree I am financially responsible for any losses and damages resulting from minor’s participation in the activity.

I certify that minor is in good health and has no medical condition preventing minor’s safe participation in this activity.  I agree to use minor’s personal medical insurance as the primary medical coverage if accident, injury, or illness occurs.  I consent to emergency medical treatment in the event such care is required.

I agree that photographs, pictures, slides, movies, video, or other media coverage of minor may be taken in connection with minor's participation in the activity, without compensation from the State of Washington, Central Washington University, and the auxiliary organizations, donors, officers, employees, volunteers, and agents of each of them (hereinafter referred to as the "Activity Coordinators and Facility Owner") and consent to the use of photographs, pictures, slides, movies, videos, and other media coverage for any legal purpose including printed publications, website, advertisements, or other media without further consideration.

In consideration for minor’s participation in the activity, I hereby waive all claims or causes of action against the Activity Coordinators and Facility Owner arising out of minor’s participation in the activity and hereby release the Activity Coordinators and Facility Owner from all liability in connection therewith.

I have read this waiver and release agreement and understand the terms used in it and their legal significance.
This waiver and release are freely and voluntarily given with the understanding that right to legal recourse against the Activity Coordinators and Facility Owner is knowingly given up in return for allowing minor’s participation in the activity.  My submission of this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.
I have read the provided program waiver and consent to my minor's participation in the Kittitas Valley Math Circle as described. *
Please type name to sign consent to the program.
Parent/ Guardian Contacts - Contact 1
Parent/ Guardian's First Name *
Parent/ Guardian's Last Name *
Parent/ Guardian's e-mail Address *
Parent/ Guardian's phone number *
Parent/ Guardian Contacts - Contact 2
Parent/ Guardian's First Name
Parent/ Guardian's Last Name
Parent/ Guardian's e-mail Address
Parent/ Guardian's phone number
Additional Student information
Please list any food allergies that will impact your student's participation in the program.
Please list below.
Please share any other health concerns that will impact your student's participation in the program:
Please list below.
Student's Grade in 2022-2023 *
Did your student previously participate in this Math Circle program? *
Note: Weather Cancellation Policy
Math Circle will be canceled if the local schools have a late start that day, cancel after-school activities that day, or if there is a published weather warning for the region. Students will be notified via parent/guardian emails if there is a cancellation.
Thank you for your registration. In submitting this application you agree your student will participate in the Math Circle meetings they registered for, Monday nights, 5:00-6:00pm. 
We look forward to seeing your family at 2022-2023 Kittitas Valley Math Circle.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms