Math Circle Registration Form

Course Name *

Important: Please make sure you select the desired course from the dropdown.

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Email

Confirm Email

Parent/Guardian Phone (main) *

Parent/Guardian Phone (secondary)

Student's Name *

First

Last

Student Date of Birth *

Student's age as of session 1 of course *

What name does student like to be called? (optional)

Student's preferred pronouns (optional)

Videoconferencing Email *

Email

Confirm Email

This is the email the student will log in with for Zoom or Google Meet. It can be a student account or a parent's account that the student will have access to.

STUDENT AGREEMENT

Reason for Participating *

Please ask your student to agree to the following: *

"I agree to do my best to participate in Math Circle as fully as I can with the goal of having fun exploring mathematics."
For in-person courses: “I understand and agree to fully follow the Math Circle COVID Safety Policy to help keep our community safe.”
"I agree to not share the link to any virtual classes with others."

If your student does not wholeheartedly agree with the items above, then Math Circle is not a good fit for your student. Please do not sign up, but do contact Rodi for other math suggestions.

Parent Agreements
I agree to remain on the physical premises during in-person Math Circle courses. If I must leave, I agree to give the Math Circle facilitator written permission for another parent/guardian on-site to supervise my child. I understand that during in-person classes Lovett Library is not guaranteed to be open and I may need to escort my child to another site to access a bathroom. If my child is under 13, I agree that a responsible adult will be in the same room as my child during virtual Math Circle courses.

Parent Agreements *

I agree to remain on the physical premises during in-person Math Circles.
I agree that a responsible adult will remain in the same room as my under-13 child during virtual Math Circles.

COVID Safety Agreement *

I agree that I have read the Math Circle COVID Safety Policy (linked below) to follow all safety policies described in the document, and that I have explained all of these policies to my child.

COVID Safety Policy (please read)

Activity Consent and Waiver of Liability
As the parent or guardian, I hereby authorize my child to participate in The Math Renaissance Math Circle. I understand that my child will be subject to the regulations of the Math Circle program. I further release Rodi Steinig, Math Renaissance, its directors, officers, employees, volunteers, students, agents, representatives, or affiliates, from any and all liability caused in whole or in part by anyone affiliated with Math Renaissance, or from any other cause whatsoever, that results in bodily injury or personal injury or a data breach suffered by above-named minor participant and for any loss or loss of use or damage to personal property owned by said participant or family member, or any other damage or injury that may result due to the above named minor’s visit or use of Math Renaissance facilities during this activity. I further understand that all Math Renaissance employees, including faculty, staff, and volunteers involved in said Math Renaissance Math Circle will exercise reasonable care and act responsibly while conducting activities.

Activity Consent and Waiver of Liability *

I agree to the above activity consent and waiver of liability

Online Risk Acknowledgement (for ALL courses, even in-person, in case we need to go virtual mid-course)
I acknowledge that transmitting information over the Internet and using telecommunications technologies have some basic inherent risks, including electronic tampering and unauthorized access by third parties. My child will only use a computer or device that you know is safe and, at a minimum, has a firewall, anti-virus software installed, is password protected, and accesses the Internet through a private, password-protected connection when participating in Math Circle. Rodi and Math Renaissance will do their best to ensure a safe environment, but as parent/guardian of this child, I acknowledge it is my responsibility to talk to them about internet safety, particularly around online classes. By checking the box below, I am agreeing that I assume this risk and do not hold Math Renaissance or any of its facilitators or volunteers liable.

Online Risk Acknowledgement *

I acknowledge my responsibility

Image Preferences and Releases
We use photos and videos of student participation and images of student work for the following purposes:
1) record of work for in-course class reference (in other words, to assist our work, so we can remember where we left off on the problem the prior week)
2) publicity in electronic and print publications and websites
3) professional development (blog posts, articles, and conference talks that benefit the larger Math Circle community)
4) emails to parents and guardians to inform about course progress

Image Preferences and Releases (Select One) *

Yes, I give permission for images of my child’s work and participation for all four purposes listed above.
No, I do not give permission for any images of my child’s work or participation for any purpose.
Yes, I give permission for images of my child’s work and participation for all of the four purposes listed above EXCEPT (Please list below what images or purposes your permission does NOT cover.)

Image Preference Exceptions

Use of Submitted Images
We invite parents and guardians to send in photos of your children participating in our virtual sessions. This gives us much more interesting photos than just the Zoom grids (in which we edit out or blur the faces and names).

Use of Submitted Images

By sending in a photo or video to the Math Renaissance Math Circle, I hereby authorize and consent to the use of this digital image (including but not limited to still photography, videotape, and audio recording) of my child by the Math Renaissance Math Circle for the purposes listed above. I give consent with no claim for payment

Would you like to be considered for a Scholarship?

Additional Comments

Phone