Studio of Engaging Math
Registration Form 2017-2018. This form is to be filled by the parent/legal guardian of the student.
Student's first name *
Your answer
Student's last name *
Your answer
Gender *
Date of birth (please enter the correct year, as well as the month and day) *
MM
/
DD
/
YYYY
School name *
Your answer
Grade in school *
Grade in our studio *
What day is your child's lesson at the studio? *
What time is the lesson?
If your child has not been assigned to the group yet, please leave this blank.
Time
:
What's the teacher's name? (if you don't know, please select "I don't know/TBA" *
Please tell us about your child’s learning strengths and weaknesses.
Your answer
Does your child experience any learning difficulties that might affect his/her performance or enjoyment of the Studio of Engaging Math? Is your child receiving any special education services in school? If so, please describe. *
Your answer
Does your child have any medical conditions or illness (asthma, diabetes, etc.), any difficulties with hearing or vision, any allergies that we should be aware of? *
Your answer
Is there any other information about your child that you would like us to know?
Your answer
Do you have other child (children) enrolled in the studio? *
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