Fill the following form to Apply at JAMS. The class size is limited, please register A.S.A.P.

	Name(Student):
	Nick Names:
	Address:
	City:
	State:
	ZIP:
	Email:
	Date of Birth:	Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
	School Grade:
	School Name:
	School Address:

Father or Legal Guardian's Info

	Name:
	Employer:
	Work Phone #:
	Home Phone #:
	Cell #:

Mother's Info

	Name:
	Employer:
	Work Phone #:
	Home Phone #:
	Cell #:

In Case of Emergency

	Contact Name:
	Address:
	Phone #:
	Cell #:

Please list Names of Other Children

	Name:    School Grade:  Age:
	Name:    School Grade:  Age:
	Name:    School Grade:  Age:

Please Provide us with your Comments

	Why Do you want your Child to Learn at JAMS (500 Characters Max):
	How is your Child Performing in Math at School (500 Characters Max):
	Where Did You Hear About JAMS (500 Characters Max):
	Additional Comments:

Please indicate your objective(s)/expectation(s)

	Acquire mental calculation skills.
	Augment current math curriculum.
	Building self-esteem.
	Build Competitiveness.
	Enhance mental dexterity.
	Attain computational efficiency in daily life.
	Enhance/Improve examination results (i.e., SAT, etc).