Mathfanatix Student Registration - JCI Barbados
We are going virtual this year. Mathfanatix is a programme designed to offer tutoring sessions in Mathematics to students who are preparing to take the 11+ Common Entrance Examination. The general aim is to improve student performance and confidence in the subject area.

We also require medical information in the event that we are able to host in person sessions.
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Email *
STUDENT DETAILS
Gender *
First Name *
Surname *
Address
Home Telephone
Mobile Telephone *
Email Address
Date of Birth (DD/MM/YYYY) *
MM
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DD
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YYYY
School Attending *
Class *
ONLINE EDUCATION RESOURCES & EXPERIENCE
Does the student have a dedicated device for online learning? *
Please choose the main/primary device the student uses for online learning. *
Is the student familiar with and comfortable with online learning? *
ACADEMIC INTEREST
Outline the specific maths topics that are hard for your child/ward and any other school specific concerns.
MEDICAL INFORMATION
If we are able to have in person sessions this information will be beneficial.
Please declare any medical issues. *
Required
Expand on any declared medical issues.
DIETARY RESTRICTIONS
Identify any dietary restrictions (Including Food Allergies eg. Pineapple) (if none, please state): *
Physician's Name *
Physician's Office Telephone *
SIGN OFF
FOR ALL PARTICIPANTS

THIS MUST BE SIGNED OR YOUR CHILD WILL NOT BE ABLE TO ATTEND TUTORIAL SESSIONS

This health history is correct as I know, and the participant has permission to engage in all tutorial sessions which is deemed to be no more than two hours. In the event I cannot be reached in an emergency, I give permission to contact the identified physician or contact the hospital to administer treatment.
Type Your Name *
Date *
MM
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DD
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YYYY
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