Please fill out all fields, print the page givin in the link, sign the permission slip and bring the form to the first meeting you attend at the Spokane Math Circle. You will only have to fill out the form once.

First name of student:

Last name of student:

First name of parent/guardian:

Last name of parent/guardian:

Contact Email (Student or Parent):

Phone Number (in case of emergency):
() -
Permission to treat (in case of emergency):
Yes: No:
Permission to take to emergency facility (in case of emergency):
Yes: No:
Physician full name:

Physician phone number:
() -
Dentist full name:

Dentist phone number:
() -
Anti-Bot Question:

This is an .