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MATH ALTHEA.doc

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  REGISTRATION FORM FOR 2018 IMWic Yes! I’m joining the 2018 International Mathematics Wizards Competition (IMWiC)  which will be held in Jakarta, Indonesia on May 4 to 7, 2018. Printed Name: CO ALTHEA MARGARETTE GAN Chinese Name: ___________________   Last Name First Name Middle Name   (Write in Chinese Characters) Gender: FEMALE Grade Level: IV Cizenship: FILIPINO Religion: ROMAN CATHOLIC Mobile #: 0927 7149537 Birth date: OCTOBER 06, 2007 Size of T-shirt:   Passport #: _________________ Date Expired: _________ Email Address: __________________________Complete Residence Address:   PUROK 5, NABBUAN SANTIAGO CITY.Name of Parents/Guardian:   JAY ARCIE S. CO Mobile # of Parents/Guardian: 0918 2222227 Tel #: ___________ Email Address:jayarcieco@yahoo.comName of School: SANTIAGO CULTURAL INSTITUTE Tel #: _______________School Address: PLARIDEL, SANTIAGO CITY Contact person in School: ENGR. JAIME GO Mobile #:    __________________ MTG Center aending now: _____________________ Name of Center Coordinator: _________________ Food you do not eat due to religion pracce or health problem:   Beef   Chicken   Pork   Fish Are you traveling with companions?   Yes   No If yes, please ll-out the following:Name of Companion 1: Name of Companion 2: CO YVONNE GRACE GAN Last Name First Name Middle Name Last Name First Name Middle Name  Chinese Name: ___________________   Chinese Name: ___________________  (Write in Chinese Character) (Write in Chinese Character)  Relaon to Parcipant:   MOTHER Relaon to Parcipant:    ______________________ Gender: FEMALE Mobile #: 0927 7154457 Gender: _______ Mobile #: _____ Birth date: SEPTEMBER 03, 1986 Size of T-shirt: __ Birth date: _______________ Size of T-shirt: _____ Passport #: P5711477A Date Expired: 21 JAN 2028 Passport #: ____________ Date Expired: ________ Religion: RC Cizenship: FIL. Religion: ____________ Cizenship:    ___________ Email Address:    _____________________________ Email Address:    _____________________________ Food you do not eat due to religion pracce or Food you do not eat due to religion pracce or health problem: health problem:    Beef   Chicken   Pork   Fish   Beef   Chicken   Pork   Fish Date: __________   A G R E E M E N T  We, JEY ARCIE S. CO AND YVONNE GRACE G. CO, who are the legal parents/guardians of ALTHEAMARGARETTE G. CO, give our consent for his/her participation in the 2018 International Mathematics WizardsCompetition (IMWiC) which will be held  Jakarta, Indonesia on May 4 to 7, 2018. and do hereby certify that we  have read the guidelines regarding the confirmation of his/her participation in the said competition.   Hence, we will followand abide the guidelines established by the MathDAP to avoid problems that may be inconvenient to other members of theteam.We further agree: a.that we adhere to the requirements on group reservation and processing of plane ticket and hotel accommodationset by the MathDAP; b.that the participants are allowed to have at most two (2) accompanying persons; andc.that we know and understand the consequences should we insist to do our own booking, that is, our child will not be considered as official member of the Philippine Team.  JAY ARCIE S. CO ALTHEA MARGARETTE G. CO Signature of Parents/Guardian over Printed Name Signature of Participant over Printed NameNOTE: PASSPORT NUMBER OF ALTHEA WILL SEND ON APRIL 18,19, 2018.
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