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BMC Elementary Wait List Application
New Students
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* Required
Last Name
*
Your answer
First Name
*
Your answer
Grade Entering Fall 2022
*
1st Grade
2nd Grade
3rd Grade
4th Grade
Other:
Preferred Time (First Choice)
*
Waiting list Grades 1-2, 5 pm
Waiting list Grades 1-2, 6 pm
Waiting list Grades 3-4, 5 or 6 pm
Waiting list Grades 3-4, 7 pm
No Preference
Preferred Time (Second Choice)
Waiting list Grades 1-2, 5 pm
Waiting list Grades 1-2, 6 pm
Waiting list Grades 3-4, 5 or 6 pm
Waiting list Grades 3-4, 7 pm
No Preference
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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.
*
Your answer
Siblings in BMC Elementary
Grades 1- 2
Grades 3 - 4
None
Clear selection
Sibling in BMC Upper
Beginners Level I from 5:00 to 6:20 PM
Beginners Level II from 6:30 to 8:00 PM
Intermediate Level I from 6:10 to 7:55 PM
Intermediate Level II from 6:00 to 8:00 PM
Advanced from 6:00 to 8:00 PM
None
Clear selection
Have you ever taken "Math Kangaroo"? IF YES, what year?
Your answer
Gender (For statistical purposes only)
*
Male
Female
Other:
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, Phone Number with area code, State
*
Your answer
Does your child have serious medical conditions? If Yes, please specify in the next section
*
Yes
No
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?
Private
Public
Other
Clear selection
Preferred Name
Your answer
What race/ethnicity do you most identify with?
African-American
Asian
Caucasian
Indian
Latino
Other:
Clear selection
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