Math tutoring contact, "keep it simple" Education Centers, kis, Buda, Kyle, Austin, Round Rock Tx

kis, keep it simple, summer math camps, math tutoring, Budaful Texas, Buda, Kyle, Austin, Round Rock, Lakeway
Registration Form

Magical Math Camp Dates Summer 2008
June 16 - 20 8:00am-3:00pm	Round Rock, TX
June 23 - 27 8:00am-3:00pm	Brentwood Christian School Austin, TX
July 14 - 18 8:00am-3:00pm	Central Austin
July 21 - 25 8:00am-3:00pm	Hays Hill Baptist Church, Buda, TX

Please provide the following?

Student's Name: Birthday: Grade Entering:

School Attending: T-Shirt Size:

Tell us how to get in touch with Contact Parent:

Name
Email
Day Phone #
Cell Phone #
Address
City, State, Zip
Employer
Employer's Address (include city)
Employer's Ph #
Second Emergency Contact Name (if contact parent unreachable)
Second Emergency Ph #

Person authorized to pickup child (children)

Child's Address if different from Contact Parent Address

Second Parent's Name different from Contact Parent

Second Parent's Address if different from Contact Parent Address

Food Allergies or Health Issues?

Medication we need to administer (must be in original containers)?

Doctor's Name & Ph #

Name of Insurance Company Ph #

Insurance Policy #

Please provide any additional information or comments that you think we may need:

How many weeks are you registering this child for?

How many children are you registering (you will need to complete a form for each child)?

Tuition is $350.00 per week or $600 for two weeks.
There is a $50.00 per week discount for siblings who also attend MMC.
You may reserve a registration for a non-refundable deposit of $50.00.
Tuition must be paid in full prior to camp start date.

(check if this applies)
I verify that this information is true and accurate.
I give "keep it simple" Education Centers permission to provide summer camp services for this child.

Person completing this form: Date:
This is considered to be an electronic signature. After you submit the form a confirmation will appear with a link for
payments. Your registration will be accepted after we receive verification of payment.

Thank you,
“keep it simple” Education & Consulting Centers