Random Math Specialized Math Classes
2021-2022

Registration Form

Contact us at learning@randommath.com for any questions.

1. Student Information

Student Full Name

School

Birthday

Grade

Does the student require any special accommodations to participate in the program?

Does your child have any allergies/intolerance to food, medication, or any other substances?

2. Parent Information

Mother's Full Name

Mother's Email

Mother's Phone Number

Father's Full Name

Father's Email

Father's Phone Number

Address

City

State

Zip Code

3. Emergency Contact Information

Emergency Contact Full Name

Emergency Contact Relationship

Emergency Contact Phone Number

Primary Doctor's Full Name

Primary Doctor's Phone Number

4. Additional Information

Authorized Person for Pickup (note: in addition to parents and emergency contacts)

How did you hear of us?

5. Class Selection

Please select your choice of specialized class:Classes Only - $1600 for 20 classes

6. Class Policies

Class Placement: Class placements would be strictly based on the student's current knowledge, commitment and priorities. Student's current math level will be assessed. The assessment data of other students will not be shared with the parents. Registration process includes submission of Registration Form and full payment of invoice.
Class Timing: We will place your child based on the assessment. Please try to be flexible to allow us to find the most appropriate class for your child.
Waiting list: We may have to place your child in the waitlist if we are unable to find spots in the most appropriate class. There may be open slots in other classrooms, but we want your child and his/her classmates to have best learning experience. At this point, wait period can be anywhere between 0-60 days.
Fee: Random Math tuition fee for the 20 classes is $1600. Discounts are provided for current Random Math students.
Refund: We have a no-refund policy for Specialized Classes.
"Taking a break" Policy: We do not have a break policy. Parents who wish to take a break would need to follow the refund process and discontinue from Random Math. Upon return, the student would need to go through an assessment and registration process followed by joining the waitlist if spots are full at the time.
Make up Policy: Students are expected to attend all classes and inform at least one week in advance of any absence. There is no refund for missed classes even if the student has not been provided a make up class.
Canceled classes: If a class is canceled due to any reason and a student is unable to attend the rescheduled class, then prorated amount would be refunded at the end of the session.
Registration: There is no registration fee for students who were enrolled into Random Math classes in May 2021. There is a non-refundable registration fee of $100 per student for new students.

7. Acknowledgement of Terms

Random Math Camp is a fee-for-service program based on confirmed enrollments and secured deposits. In order to reserve your child(ren)’s spot, full payment must be received for each child and session you are registering for. Student(s) would need to take an assessment before placement can be confirmed.
I HAVE CAREFULLY READ THE RANDOM MATH CLASS POLICIES. MY SIGNATURE BELOW INDICATES COMPLIANCE WITH RANDOM MATH POLICIES. I SIGN IT FREELY AND VOLUNTARILY.
Parent or Guardian - You will be required to review and sign the registration form on the first day of the session.

Parent or Guardian Signature

Date

I agree to receiving marketing and promotional materials.

Thank you! Your submission has been received!

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Random Math Specialized Math Classes2021-2022