Math Monday Registration Please complete the form below and contact us by email or at 504-475-4522 to make arrangements to drop off your payment or mail a check or money order to the Learning Laboratory at 7100 St. Charles Avenue, New Orleans, LA 70118. Online Payment is also now available at http://mkt.com/learnlabnola. Add "Math Monday" to your cart and pay with your credit or debit card. There is a 5% fee for this service. The total cost of Math Monday is $500 per ten-week session or a drop-In rate of $50 per week with a $25 registration fee to cover materials. Step 1 of 4 25% Payment Method*YOUR CHILD WILL BE UNABLE TO ATTEND MATH MONDAY UNTIL PAYMENT IS COMPLETE.Online with debit/credit card (+5% processing fee added)Check/ Money order by mailCash in personHow did you find out about Math Monday?*Math Monday/ Genius Camp/ Kwanzaa Camp ParentEmailFacebookRadioWord of MouthProgram DetailsMath Monday is a 10-week after-school program for learners in grades K-6. Please read and acknowledge the following details before completing registration. The program for ten weeks from 5-6 p.m. on Monday night with a one-hour session for homework help at 4-5 p.m. Parents are asked to drop off and pick up learners in a timely manner. Drop offs begin at 4:00 p.m. and pickups end at 6:05 p.m. Absences, late dropoffs and early pickups are strongly discouraged to ensure that each learner is present for the full program schedule. Pickups after 6:05 will be charged at a rate of $1 per minute. Math Monday parents and extended family members are invited to attend "Family Math Night" on November 27, 2017 from 5 to 6 p.m. for learners to share their work with parents and community members. Parent/Guardian InformationParent/Guardian Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/ Guardian Email Address Enter Email Confirm Email Primary Phone*Please provide a number (preferably mobile) that we can use to contact you if we need to talk to you about your child during the program.Alternate Phone*Please provide a secondary number that we can use to contact you if we need to talk to you about your child during the program.I would like to register ____ child(ren).*123 Student InformationStudent #1 Name* First Last Student #1 Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #1 Grade Level for 2017-18 School Year*Grade must be between K (enter '0') and 6 for registration. Please enter a value between 0 and 6.Please share any information we need to know about this student (#1)i.e food allergies, learning concerns, etc.Student #2 Name* First Last Student #2 Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #2 Grade Level for 2017-18 School Year*Grade must be between K (enter '0') and 6 for registration. Please enter a value between 0 and 6.Please share any information we need to know about this student (#2)i.e food allergies, learning concerns, etc.Student #3 Name* First Last Student #3 Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student #3 Grade Level for 2017-18 School Year*Grade must be between K (enter '0') and 6 for registration. Please enter a value between 0 and 6.Please share any information we need to know about this student (#3)i.e food allergies, learning concerns, etc. Emergency InformationEmergency Contact*Please provide the name of someone we can contact if the parent/guardian listed above is unavailable in the case of an emergency. First Last Relationship to student(s)*Emergency Contact Phone Number*Emergency Contact Alternate Phone Number Informed Consent and AcknowledgementIn consideration of my child’s participation in programs provided by the The Learning Laboratory New Orleans, Inc., I indemnify and hold The Learning Laboratory New Orleans, Inc. and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release The Learning Laboratory New Orleans, Inc. and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that The Learning Laboratory New Orleans, Inc. does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities. I give permission for my child’s photo and/or likeness to be retained and used by The Learning Laboratory New Orleans, Inc. without any remuneration or compensation. BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.Electronic Signature*Type your name First Last PhoneThis field is for validation purposes and should be left unchanged.