Registration Form

Please fill in all fields marked with a *
	First Name	*
	Last Name	*
	Telephone Number (xxx-xxx-xxxx)	*
	Email Address	*
	Zip Code	*
	Sex	Male     Female*
	Date of Birth (month/day/year)	*
	Please Select a Program and Date*	Day of Memorization 03/13/10	Day of Remediation - Math 03/20/10
I understand that, in order to be admitted to the Day of Remediation - Math, I must pass a Times Tables Quiz that will be administered at the beginning of class. I understand that to "pass the Times Tables Quiz" means I must score at least 92% (46 out of 50 questions) correct in one minute or less.   I understand that if I arrive later than 8:00 a.m. for the Day of Memorization or 7:45 a.m. for the Day of Remediation - Math I will not be admitted to the class.   I understand that the use of electronic devises (e.g., cell phones, ipods/mp3 players, laptop computers, etc.) is not permitted under any circumstances during math class time; and that if I do use one of these forbidding devises I will be expelled from the class.

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