2019 SFU-CMS-PIMS Summer Math Camp
Surrey Campus

June 25 - 26, 2019
Student Acceptance Package

Please Submit By June 14th

Before you begin the Acceptance Package, please be aware that you will also be expected to submit your payment info at this time.  Please do not start the package if you are not ready to pay at this time.

Student Information

Please indicate if student's email address can be shared with camp participants

T-Shirt Size

Please note that we will do our best to match up the correct size for the student, but we can not guarantee their size will be available.
Preferred T-Shirt Size

Student Health Record

Does student have allergies (including allergies to medication)?
Has student had any recent injuries or accidents requiring medical attention?
Has student had any sickness lasting longer than 1 week within the past 12 months?
Does student take medication on a regular basis?
Does student have a condition presently under a physician's or dentist's care?
Are there any dietary restrictions or special needs that we should be aware of?
If you answered "YES" to any of these health questiions, please explain here (with names & dates)
Has student completed poliomyelitis immunization by injections (Salk) or vaccine by mouth (Sabin)?
Has student had tetanus toxoid and booster inoculation within the past 10 years?
Is student in general good health with no serious physical impairments?
If you answered "NO" to any of these questions, please explain here (with names & dates)

Parent/Guardian & Emergency Contact Info

Release & Indemnity Agreement

Photography Release

I give the Canadian Mathematical Society and Simon Fraser University permission to reproduce photograph(s) taken at the 2019 SFU-CMS-PIMS Surrey Summer Math Camp on June 25-26, 2019, containing said Student, and I agree that the Canadian Mathematical Society and Simon Fraser University are entitled to use the photograph(s) described above in promotional materials.

Payment Options

payment option