Summer Math Program Registration 2023

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Hello loving parents & guardians!

Welcome back to our registration form!

Medical information can be email/submitted to the office separately.
Payments can be coordinated with the program director, Tamim Suhail.

Our last question will ask you to describe your child's interests/hobbies,
and if you have any areas of concern regarding their math development.

Feel free to text or call Tamim at anytime, 347-882-3455

Mathematically,
Tamim Suhail

Names of Parent(s)/Guardian(s) *

Name of Child *

Does your child have any allergies? Or important medical circumstances? If yes, please describe. *

Phone numbers of Parent(s)/Guardian(s)

Alternate Emergency Contacts: Name/relation/phone number

Pick up permission: Names/relation/phone number

What grade & school will they be in next year 2023-2024? *

Weeks Interested *

Week 1: July 5th - July 7th (3 days - Discounted)

Week 2: July 10th - July 14th (5 days)

Week 3: July 17th - July 21nd (5 days)

Week 4: July 24th - July 28th (5 days)

Week 5: July 31st - August 4th (5 days)

Week 6: Aug. 7th - Aug. 11th (5 days)

Week 7: Aug. 14th - Aug. 18th (5 days)

Week 8: Aug. 21st - Aug. 25th (5 days)

Week 9: Aug. 28th - Sept. 1st (5 days)

Required

Preferred Drop off & Pick Up Options

Standard Drop off is 9AM & Pick up is 3PM. Please indicate your possible need for extended day options of 8AM/5PM.

Might need sometimes

Will not need

8am ($10/day)

5pm ($20/day)

Please describe your child's favorite interests & hobbies, as well as a brief description of their math abilities, and your areas of concern regarding their math development.

Please let us know what other questions/comments you may have?

THANK YOU VERY MUCH!

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