5th Grade Enrichment Registration

Enrichment Registration Form - Colter Elementary 5th Grade "Crypto Club"

Please fill out this form to register your 5th grade child for the 5th Grade math "Crypto Club" at Colter Elementary School. This intensive is for students working at an advanced level with mathematical skills. "Crypto Club" will run from 2:45-3:45PM on Tuesdays from October 6th until November 10th. IMPORTANT - PLEASE READ: Space is limited. A weighted lottery will be run on WEDNESDAY, SEPTEMBER 30TH and all participants will be notified of acceptance into the program or onto the wait list on THURSDAY, OCTOBER 1ST.
Parent's Full Name

First NameLast Name
Parent's Email Address
example@example.com
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student's Name

First NameLast Name
Child's Race/Ethnicity
Does your child qualify for free or reduced lunch?
I confirm that my student is in 5th grade, enrolled at Colter Elementary School, and is performing at an "advanced" level in math (as evidenced by WYTOPP scores or teacher feedback).
I understand that if my student has two unexcused absences, my student will be unenrolled from the program to make room for a student on the wait list.
Emergency Contact (adult available during program hours)

First NameLast Name
Emergency Contact Phone Number (adult available during program hours)
Please enter a valid phone number.Format: (000) 000-0000.
Please indicate your preference for student pick up. Please note, all students must be picked up at 3:45PM from Colter Elementary School.
I understand that Elevate Math WY’s responsibility for my child ends at the official program end time, and acknowledge that Elevate Math WY is not responsible for my child’s supervision or safety after the program has ended.
Please note any special concerns you have for your child here (e.g., academic needs, allergies, etc.)
This free program is supported in part by the Education and Families Initiative Grant Fund of the Community Foundation of Jackson Hole.
Should be Empty:

Enrichment Registration Form - Colter Elementary 5th Grade "Crypto Club"