4th Grade Class Sign Up Form Student Name * First Name Last Name Email * Parent or student email. This is where communication and important documents will be sent, so please put the best email for contact. Student's Age * Last math level student has completed? * Parent/Guardian Name * First Name Last Name Parent/ Guardian Phone Number * (###) ### #### Can I text this number? Yes No Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Relationship to child? How is the emergency contact related to the student? Does your student have any allergies? If yes, please list below. Payment Plan * *Please note: CASH payments are received in cash, check, Venmo, Cash App, and Zelle. Pay full amount in CASH at the beginning of the semester. Pay monthly (at the beginning of the month) in CASH. Pay monthly (at the beginning of the month) in CHARTER FUNDS. Thank you! You will receive an email from me shortly to complete the sign up process for your student!