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Returning Student * Yes No

Student First Name *

Student Last Name *

School Board * KPRDSB WRDSB PVNCC BHNCDSB KPDSB Other

Student OEN Number

Student Email Address * Each student will need their own email address. We suggest using their school board email assigned to them. A Gmail address will also work

Student Is Currently In Grade * Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Individual Board programming may be limited to certain grades.

School *

Parent Name *

Parent Mobile Number *

Parent Email Address *

Mailing Address We will send your child a package in the mail containing math manipulatives for use during their DropKicking Sessions.

Session Availability Weekday Afternoon 4pm - 5pm (EST) Weekday Evening 6-9pm (EST) *Exact one-hour timeslot will be allocated upon registration. Weekend Morning 9 - 11am (EST) *Exact one-hour timeslot will be allocated upon registration. Weekend Afternoon 1 - 4pm (EST) *Exact one-hour timeslot will be allocated upon registration. Start times will be assigned based on availability. All programs run for 1 hour a week, for 6 weeks. Please choose the session that will work best for your child.

Day of the Week Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Report Card As per program guidelines we are required to have a copy of the latest report card for the student. Please take a picture or scan the report card and upload it here. If you can't upload it now please email the report card & student name to info@dropkickmath.com

Math mark on report card

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How did you hear about us? Search engine (Google, Yahoo, etc.) Social Media (Twitter, Facebook etc.) Email from school board Recommended by friend Other

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