Math Club Application Form - Laureates Academy for Gifted Students

REGISTRATION FORMS MUST BE COMPLETED ACCURATELY AND, IN THEIR ENTIRETY, TO ENSURE A SPOT IS RESERVED FOR YOUR CHILD. PLEASE ENSURE ALL SECTIONS ARE FILLED OUT FULLY BEFORE SUBMISSION TO AVOID REGISTRATION DELAYS.

Checkboxes

I AM A RETURNING STUDENT AND MY CONTACT INFO HAS NOT CHANGED (PLEASE FILL IN THE STUDENT FIRST NAME, LAST NAME, ENTRY GRADE, IEP, AND GENDER)
I AM A RETURNING STUDENT AND MY CONTACT INFO HAS CHANGED (PLEASE FILL OUT THE ENTIRE APPLICATION FORM)
I AM A NEW STUDENT (PLEASE FILL OUT THE ENTIRE APPLICATION FORM)

1. STUDENT INFORMATION

Name

First

Last

Grade

Birth Date

Gender

Male
Female
Not Specified

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

2. PARENT/GUARDIAN INFORMATION

Primary Contact

Parent/Guardian 1
Parent/Guardian 2
Both

PARENT/GUARDIAN1:

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Cell Phone Number

Home Phone Number

Email

Occupation

PARENT/GUARDIAN2:

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone Number

Phone

Email

Occupation

3. FORMER SCHOOL INFORMATION

School Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

4. PAYMENT OPTIONS ($3,000 FOR 80 Classes Annually)

Package

One Payment Upon Registration ($200 discount)
Two Payments 3 Months Apart ($100 discount)
Three Payments, 3 Month Apart (No doscount)

5. ADDITIONAL SERVICES

Package

March Camp 2024 (March 11 to March 22): $720 (for early registration before September 1, 2024)
Summer Camp A 2024 (July 2 to July 12): $720 (for early registration before September 1, 2024)
Summer Camp B 2024 (July 15 to July 26): $720 (for early registration before September 1, 2024)
Summer Camp C 2024 (July 29 to August 9): $720 (for early registration before September 1, 2024)
Summer Camp D 2024 (August 12 to August 23): $720 (for early registration before September 1, 2024)
Math Club (80 sessions per year): $2,700 (for early registration before September 1, 2024)