Parent Name *

First Name

Last Name

Participant's (Your Child's) Name *

First Name

Last Name

Grade Student is Entering in Fall 2025 *

Grade 6

Grade 7

Grade 8

Grade 9

Student Gender *

Male

Female

Non-binary

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 6pm and 8 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 6 pm and after 8 pm on a given day of the Algebra I Review Workshop. If DCSMI determines, in its sole and exclusive discretion, that my child’s behavior disrupts or negatively impacts the experience of other DCSMI participants in the workshop, and/or if he or she does not comply with the reasonable behavioral guidelines given by the instructor, he or she may be asked to leave the workshop, with no refund. I understand that the tuition payment is 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. F 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:

Date of Electronic Signature *

MM

DD

YYYY