jmmkids

We'll handle the kid stuff.	Children's Program Registration Form - Joint Mathematics Meetings- January 9-12, 2013

There are two ways you can register for the children's program:
1. Complete and submit the online form listed below.
2. Download the Adobe Acrobat version of this form to mail or fax to us, click here: Acrobat Version of Registration Form.
It is not necessary to do both.

Where, When, For Whom

The children's program is for children ages 6 months through 12 years old and will be located at the San Diego Marriott Marquis in San Diego, California. Snacks and beverages will be provided. Meals can be supplied by parents or purchased when checking your child in each day.

Medication will NOT be administered by KiddieCorp. Be sure to fill out the following form COMPLETELY. To ensure a safe and fun-filled environment, any child who is ill will not be admitted to the children's program.

The cost for the children's program is $14.00 per hour, per child or $10.00 per hour, per child if you are a Graduate Student, plus a $30.00 (nonrefundable) registration fee per family.

The advance registration deadline is December 12, 2012. Register early as availability is limited and handled on a first-come, first-served basis. This form must be completed in its entirety and payment received before registration is confirmed.

Cancellations must be made to KiddieCorp prior to December 12, 2012 for a full refund. Cancellations made after that date will be subject to a 50% cancellation fee. Once the program has begun, no refunds will be issued.

Parent Information:

Parent Name(s):

Home Phone:

Work Phone:

E-mail Address:

Full Mailing Address:

Check here if your child(ren) has/have any special needs under the Americans with Disabilities Act. We will contact you so that we may make appropriate arrangements to accommodate your child. Please provide details in the box below.

Check here if any of your children have health limitations or special needs. Please let us know so that we may ensure your child(ren)'s needs are met. Please provide details in the box below.

Child(ren)'s Names and Ages

1. Name: Age: At the time of the meeting.

2. Name: Age: At the time of the meeting.

3. Name: Age: At the time of the meeting.

4. Name: Age: At the time of the meeting.

5. Name: Age: At the time of the meeting.

Dates & Times

Wednesday, January 9-- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Thursday, January 10-- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Friday, January 11-- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Saturday, January 12-- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Please feel free to provide any additional details in the box below.

Payment in full is required to confirm your reservations. Although every effort will be made to accommodate late or on-site registrations, there is no guarantee that KiddieCorp can accept children unless they are pre-registered. When you arrive at the children's program we will take a security photo of your family and have you complete a consent form.

Calculating Fees & Payment Options:

Registration Fee (nonrefundable):

$30.00 per family =

PLUS

Hourly Fee:

$14.00 per hour, per child X # of Children X # of Hours*=

Grad Students:

$10.00 per hour, per child X # of Children X # of Hours*=

TOTAL =

*Children must be registered for a minimum of two consecutive hours per child, per day.

The American Mathematical Society and the Mathematical Association of America subsidize this service by paying most of the cost.

KiddieCorp accepts checks and money orders (in U.S. dollars only), MasterCard, Visa and American Express.

If you are paying by credit card, please enter your card number and print a copy of this completed registration form for your records BEFORE you submit on-line. If you prefer, you may fax the form to (858) 455-5841.

Credit Card Number: Expiration Date: VPN:

Billing Address (if different from mailing address):

Check here if you are paying by check.

If you are paying by check, please print two copies of this completed registration form. Keep one copy for your records and mail the other copy along with your check or money order to:

KiddieCorp/JMM
8961 Complex Drive
San Diego, CA 92123
(858) 455-1718