Sunday, May 6th, 2018 Berryessa Kumon Center 10:00AM – 11:00AM 1030 Piedmont Road, Suite G

 Registration Deadline: Monday, April 30th, 2018

Registration Fee: $15.00 Forms of Payment: Cash or Check

(Please prepare exact change.)  

 

Student First Name _______________________ Last Name____________________ Grade (tick): qK & Under q1 q2 q3 q4 q5 q6 q7 q8 q9 &

Above

 Parent Signature* & Date: ____________________________ ____/____/_______

1 Check-in will start 30 minutes before the Test Time. 2 Please bring your own pencils and erasers. 3 Students will complete based on their current grade level. (September 2017

grade) 4 Registration fee includes test entrance and TWO presents. 5 Submit the Participation Form below and the registration fee before

April 30th. 6 Math Contest results will be announced within 2 weeks after the test date.

*By signing above you grand the participation Kumon centers the right to use, incorporate, or publish and materials including but not limited to tests, results, names, photographs or video footage taken of you or your child(ren) as a result of participation in this event. The amount of award and number of winners will depend on how many participants are in each level.  

FOR OFFICE USE ONLY. DO NOT WRITE.

q PAID