I am registering for: *

Sunday Morning Math Club

Sunday Afternoon Math Club

Parent/Guardian *

First Name

Last Name

Student (Your Child) *

First Name

Last Name

Gender *

Male

Female

Other

Waiver *

I, the Parent or Guardian, hereby give consent for the Student to attend the Workshop/Camp(s) offered by the Vancouver Independent School for Science and Technology (VISST) on their premises at 1490 W Broadway, Vancouver, during the camp dates/times listed on the VISST website. I acknowledge that there are inherent risks and liabilities in allowing my child to participate in workshop/camp activities with other students, and on behalf of the Student, release VISST from liability, and waive any claims the Student may have as a result of an incident during the Workshop/Camp. I authorize staff members and volunteers of VISST to act appropriately as they see fit during the Workshop/Camp in unexpected or emergency situations. I further acknowledge that photographs or videos may be taken by VISST or by others attending the Camp (but we will only publicize these photos with your consent, see next question).

I agree

Photo Consent *

Photos are an important way for us to make learning visible at VISST. However, VISST does not wish to use photos without your clear consent. Please indicate below whether you consent to your child appearing in School materials like a yearbook, wall photo, social media or website page:

I consent to use of photos

I do not consent to use of photos

Emergency Contact Phone *

In case of an emergency, at what number can we reach you?

(###)

###

####

Name on Card *

First Name

Last Name

Authorization *

I hereby authorize VISST to charge my credit card on the first of every month for the workshops/classes of the upcoming month.

I authorize