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* What is your name?

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* What is your email? 

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* What is your child's name?

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* What is your child's gender? 

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* What is your child's grade?

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* What is your child's math level?

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* How does your child feel about math? Check all that apply.

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* What would you most like your child to get out of a math circle? Check all that apply.

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* What are the best days for your child to participate in a math circle? (Check all that apply.)

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* Math circles are an hour and a half long, once a week. Please check the time frames your child would be able to attend math circles.

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