Parent Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

DCSMI Participant's (Your Child's) Name

First Name

Last Name

Grade Student is Entering in Fall 2024 *

Grade 6

Grade 7

Grade 8

Grade 9

Student Gender

Male

Female

Non-binary

Is your child a returning DCSMI participant? *

Yes

No

Parent Agreement - If you agree with the policies outlined below, please check the I Agree box below, and write the current date in the field provided *

As a parent, I acknowledge that DC Summer Math Institute, Inc. (DCSMI) is only responsible for the instruction of my child (named above) only between the hours of 1 pm and 5 pm when he or she is connected online to the Institute. DCSMI will also not be held responsible for my child’s behavior online before 1 pm or after 5 pm on a given day of the Institute. If DCSMI determines, in its sole and exclusive discretion, that my child’s behavior disrupts or negatively impacts the experience of other DCSMI participants, and/or if he or she does not comply with the reasonable behavioral guidelines given by DCSMI staff, he or she may be asked to leave DCSMI, with no refund. I understand that both the initial 50% tuition deposit and remaining tuition balance are both absolutely and unequivocally non-refundable, even in the case of family emergencies. I also understand that I will be responsible for avoiding payment transaction fees by choosing the Payment between Friends option on Venmo or PayPal (NOT the Goods and Services option), and that in the event that fees are incurred accidentally, I will have to cover the payment of those fees. Finally, by signing this agreement, I am committing to my child attending DCSMI for the FULL two weeks, instead of one week only. I realize this policy is necessary so that all spots are fully maximized and utilized throughout the two week session by students who want to attend.

I Agree to the policies outlined above, on this date:

Financial Aid (OPTIONAL) - For Sidwell Friends students only who are currently receiving financial aid who would like to receive financial aid for the DCSMI tuition

All DCSMI participants who are Sidwell Friends students that currently receive financial aid are entitled to financial aid for the DC Summer Math Institute at the same percentage discount being applied to their school year tuition. This percentage discount will be applied after consultation with the SFS Admission Office. Note: If you are a DCPS student receiving a full scholarship, you do NOT need to check this box.

I currently receive financial from Sidwell Friends School and would like to apply for financial aid to the DC Summer Math Institute. I give the DC Summer Math Institute permission to seek the percentage discount rate on my school year tuition from the Sidwell Friends Admissions Office, with the understanding that it will be kept confidential and used only for the purpose of calculating the discounted tuition amount for the DC Summer Math Institute

Parent Name *

Parent Name

First Name

Last Name

Parent Cell Number (digits only - no dashes) *

(###)

###

####

DCSMI Participant's (Your Child's) Name *

First Name

Last Name

All participants will have to the option to be loaned a Surface Pro 2-in-1 laptop device for use during the camp, free of charge. The Surface Pro includes both a stylus to use on its touchscreen and a built-in keyboard. In order for your child to be loaned the Surface Pro device, you must commit to picking up the loaned device on Saturday, June 15th or Sunday, June 16th, 2024 from the Sidwell Friends parking garage, and dropping off the loaned device on Saturday June 29th, 2024 or Sunday, June 30th, 2024 at the same location. You may also choose to have your child use his or her own device (such as an IPad or laptop) instead of being loaned the Surface Pro. Please choose one of the three options below. *

I would definitely like my child to be loaned the Surface Pro device from June 15th, 2024 to June 30th, 2024.

There is a chance that my child will not need to be loaned the Surface Pro device, and instead will be using another device of his or her own

My child will definitely NOT not need to be loaned the Surface Pro device, and will be using a device of their own such as a laptop or IPad. (If the latter is being used, a stylus and bluetooth keyboard is recommended for a smooth interactive experience with the camp.)

Surface Pro Loan Agreement *

If I decide to loan a Surface Pro from the DC Summer Math Institute, I agree to pick up the Surface Pro device and charger on Saturday, June 15th, 2024 or Sunday June 16th, 2024 and drop them off Saturday June 29th or Sunday, June 30th, 2024 at the Sidwell Friends Parking Garage at 3825 Wisconsin Ave, NW Washington, DC 20016. I agree to return the Surface Pro device and charger in good condition, reasonable wear and tear excepted on Saturday, June 15th, 2024 or Sunday, June 16th, 2024. While some arrangements for return prior to June 29th-30th might be possible through another camp participant in extreme circumstances, the DC Summer Math Institute cannot guarantee this will be possible. I understand that if I do not return the Surface Pro device and charger by the June 29th-30th deadline, I will be charged a $115 late return fee, paid to the DC Summer Math Institute. (For each subsequent two-week interval following June 30th for which the equipment are not returned, another $115 late fee will be charged, paid to the DC Summer Math Institute.). I agree to pay for and be responsible for the damage to the Surface Pro device and charger, and to pay the DC Summer Math Institute the retail value of the Equipment in the event it is lost, damaged, or destroyed by fire, theft or any other cause or misuse/neglect. I understand that if there is damage to the equipment, I will be responsible to pay The DC Summer Math Institute 100% of the replacement or repair costs. Below are the replacement values of the equipment: Surface Pro and charger: $700 Surface Pen: $50

I agree to the terms listed above, including payments that would be immediately due to DC Summer Math Institute if the IPad and/or accessories were lost/damaged/stolen, and/or if the equipment was not returned on time. I understand that clicking this button serves as an electronic signature for this agreement.

Date of Electronic Signature *

MM

DD

YYYY