NYMC - Registration

Registration for "HSA+"

When:

Sundays, 1pm - 3pm
1/10, 1/17, 1/24, 1/31, 2/7,~~2/14~~,~~2/21~~,2/28,3/7, 3/14,~~3/21~~,~~3/28~~,~~4/4~~,4/11,4/18

Where:

Online.

Instructor:

Jan Siwanowicz.

Registration fee:

$345. (Fee may be reduced based on financial need; see FAQ).

This registration is for the waiting list only. We will email you if a spot opens up.

Parental consent is required.

Required fields are bold.

Student's name:	First	Last
E-mail address:	Phone:
Zip Code:
School:
Grade:	(as of Spring 2021) Gender: M F
How did you hear about us?
The student’s parent or legal guardian must read and fill out the portion below: I am giving permission for the student named above to attend classes at New York Math Circle. I acknowledge that I am aware of the nature of the program, and I assume all risks associated with participation. I also agree to take full responsibility for the student’s transportation to and from the site. I understand that students may have their participation terminated if they fail to observe reasonable rules of good conduct, or if they disrupt the learning of others. I also acknowledge that participation in NYMC is completely voluntary and will not result in academic credit. I confirm that I am the student's parent or legal guardian, and that I agree with the above.
Parent's name:	First	Last
E-mail address:	Phone:
In case of emergency, contact me at:
Any comments, or any special situations we need to know about?