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Math Summer Camp 2015 Savannah Registration Form

Summer Camp (circle one) Math 1 Math 2 Math 3

Student’s Name: ______________________________________________________________________
Student’s Age: _______ Upcoming Grade Level: _________
Parent/Guardian: _____________________________________________________________________
Address: _______________________________________________________________________________
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Phone: (Home) ____________________________ (Cell) _____________________________________
Email: _____________________________________________________________________________________
Any allergy, medical concerns, or other pertinent information we need to know: _________________________________________________________________________________________________
Emergency Contact Name: ______________________________________Phone: ______________________
Relationship to student: _______________________________________

*I will not hold any teacher, the facility, or anyone associated with the MathMasters program or facility, responsible for any personal injury or damage and/or loss to my child’s property.
Signed: __________________________________________________________ Date: _______________________
*Please send completed registration form along with the $25 non-refundable registration fee to Becky Foxworth at:

Becky Foxworth
105 East Back Street
Savannah, GA 31419

*$100 camp fee is due by the first class.

For details about math camps, click here.