Date & Time
Date(s) - 10/06/20183:30 pm - 5:30 pm
Charney Hall - Santa Clara University
500 El Camino Real
Student's Name *
School Name (or Home School) *
Grade Level *
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Please alert us to any mobility issues, or other special needs we should be aware of for this student.
Relationship to Student *
Parent/Guardian Teacher Other
Photo Waiver Terms
I, the undersigned, am the parent/legal guardian of this student OR I have permission from this student's parent/legal guardian, and I hereby grant the Julia Robinson Mathematics Festival permission to publish: my photograph/s and this student's photograph/s in Festival publications and/or on the websites of the Julia Robinson Mathematics Festival (www.jrmf.org) and associated organizations (aimath.org, msri.org) as well as any organization providing publicity for the Festivals. I understand that I have the right to request, in writing, removal of the photo from the Festival websites within 30 working days of receipt of the request by the JRMF. I understand that this photo may be used in Festival publications or on a website designed to promote the Festival programs as well as to offer information and resources.
Photo Waiver *
YES, I acknowledge my understanding of the above and grant my permission for use of the photograph(s). NO, I do NOT grant my permission for use of the photograph/s.
Your Name *
Parental Consent *
YES, I am the parent/legal guardian of the above listed student(s) OR I have permission from a parent/legal guardian for EACH student listed above.
I consent to my submitted data being collected and stored as outlined by the site .
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