Name of Parent (required)

Name of Participant (required)

School of Participant (required)

Grade of Participant (required)

Email (required)

Phone Number of Parent (required)

Home Address (required)

How did you hear about Mission Math? (required)

Additional Information (food allergies, etc.)

LIABILITY WAIVER: This agreement releases Mission Math and The University of Utah from all liability relating to injuries that may occur during the Mission Math Winter Camp at The University of Utah. By signing this agreement, I agree to hold Mission Math entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. In return, I will receive participation in the Mission Math Winter Camp. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. Electronically sign your name below. (required)