BMC Elementary Wait List Application
New Students
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Last Name *
First Name *
Grade Entering Fall 2022 *
Preferred Time (First Choice) *
Preferred Time (Second Choice)
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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. *
Siblings in BMC Elementary
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Sibling in BMC Upper
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Have you ever taken "Math Kangaroo"? IF YES, what year?
Gender (For statistical purposes only) *
Parent 1 email *
Parent 2 email
Parent 1 Name *
Parent 2 Name
Parent 1 Phone *
Parent 2 Phone
Out-of-State Emergency Contact: Name, Phone Number with area code, State *
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
Student's Address (Street/City/State/Zip Code)
School, Name, Address
What kind of school do you go to?
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Preferred Name
What race/ethnicity do you most identify with?
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