B-RELYT Membership Registration and Registration 2026–2027 Programs
Mission: To empower, uplift, and expand opportunities through Math for all communities.
The B-RELYT Organization, Inc dba B-RELYT Math Collective
Overview
To support long-term sustainability and ensure we can continue delivering high-quality programs, BMC is transitioning to a membership model. Your support is so important. As a registered 501(c)(3) nonprofit, your membership fee is tax-deductible. Membership is per household and covers all students residing at the same address.
BMC Membership Benefits
Are you a returning member?
Yes
No
Parent/Guardian Information
Parent/Guardian 1 Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email - Parent/Guardian 1
*
example@example.com
Cell Phone - Parent/Guardian 1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian 2 Full Name
First Name
Last Name
Email - Parent/Guardian 2
Cell Phone - Parent/Guardian 2
Does the student live at Parent/Guardian 1’s address? If no enter Parent/Guardian 2’s address below. Otherwise write N/A
*
Emergency Contact Information
Emergency Contact Full Name
*
First Name
Last Name
Cell Phone- Emergency Contact
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to student
*
Family
Guardian
Relative
Friend
Other
Student Information
How many students are in your family?
*
1
2
3
4
Student 1 Full Name
*
First Name
Last Name
Grade of Student 1 (2026–2027)
*
Please Select
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Date of Birth Student 1
*
-
Month
-
Day
Year
School of Student 1
*
What Math will Student 1 be taking Fall 2026?
*
Elementary School Math
Middle School Math
Algebra 1
Geometry
Algebra Pre-Calc/Trig
Calculus 1
Other
Which Program are you registering your child for?
*
Summer Math Intensive – Hybrid (Grades 6–12)
Saturday School (K–8th grade)
In-Person Math Revolution @ UCLA (2nd–8th grade)
BMC Pathway - FREE non-profit program either 1:1 or group math tutoring weekly. Sponsored by Amity Foundation, CFCI and JCOD
Student 2 Full Name
*
First Name
Last Name
Grade of Student 2 (2026–2027)
*
Please Select
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Date of Birth Student 2
*
-
Month
-
Day
Year
School of Student 2
*
What Math will Student 2 be taking Fall 2026?
*
Elementary School Math
Middle School Math
Algebra 1
Geometry
Algebra Pre-Calc/Trig
Calculus 1
Other
Which Program are you registering Student #2 for?
*
Summer Math Intensive – Hybrid (Grades 6–12)
Saturday School (K–8th grade)
Math Revolution @ UCLA (2nd–8th grade)
BMC Pathway - FREE non-profit program either 1:1 or group math tutoring weekly. Sponsored by Amity Foundation, CFCI and JCOD
Student 3 Full Name
*
First Name
Last Name
Grade of Student 3 (2026–2027)
*
Please Select
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Date of Birth Student 3
*
-
Month
-
Day
Year
School of Student 3
*
What Math will Student #3 be taking Fall 2026?
*
Elementary School Math
Middle School Math
Algebra 1
Geometry
Algebra Pre-Calc/Trig
Calculus 1
Other
Which Program are you registering Student #3 for?
*
Summer Math Intensive – Hybrid (Grades 6–12)
Saturday School (K–8th grade)
In-person Math Revolution @ UCLA (2nd–8th grade)
BMC Pathway - FREE non-profit program either 1:1 or group math tutoring weekly. Sponsored by Amity Foundation, CFCI and JCOD
Student 4 Full Name
*
First Name
Last Name
Grade of Student 4 (2026–2027)
*
Please Select
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Date of Birth Student 4
*
-
Month
-
Day
Year
School of Student 4
*
What Math will Student #4 be taking Fall 2026?
*
Elementary School Math
Middle School Math
Algebra 1
Geometry
Algebra Pre-Calc/Trig
Calculus 1
Other
Which Program are you registering Student #4 for?
*
Summer Math Intensive – Hybrid (Grades 6–12)
Saturday School (K–8th grade)
In-Person Math Revolution @ UCLA (2nd–8th grade)
BMC Pathway - FREE non-profit program either 1:1 or group math tutoring weekly. Sponsored by Amity Foundation, CFCI and JCOD
Media Release & Liability Waivers
Please read and check all boxes below
*
General Release of Liability:On behalf of myself and my minor child, I voluntarily release, discharge, indemnify, andagree to hold harmless B-RELYT/BMC and its officers, employees, agents, and representatives (“BMC Parties”) from any and all claims, liabilities, damages, losses,expenses (including attorney’s fees), or causes of action—known or unknown, anticipated or unanticipated, including those seeking equitable or declaratory relief—arising directly or indirectly from my child’s participation in programs offered by BMC Parties(“Release”). This Release is intended to be as broad and inclusive as permitted by law,and if any portion is held invalid, the remainder shall remain in full force and effect. I further expressly waive all rights under Section 1542 of the California Civil Code, which states:“A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release, and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.”I understand that unknown or unforeseen facts may later arise but agree that this Release shall remain fully effective regardless of any such discoveries.
Acknowledgment of Separate Waiver: I acknowledge receipt of, and agree to execute, any additional separate Release andWaiver of Liability for participation in specific BMC programs.
Non-Refundable: I acknowledge and agree that all fees paid to B-RELYT/BMC are non-refundable. I further understand that B-RELYT/BMC is a nonprofit organization, and that payments made may be tax-deductible to the extent allowed by law.
Media Release: I grant permission for BMC Parties to photograph or record my minor child duringprogram participation and to use such images and likeness in promotional or educationalmaterials or, if I wish to opt-out, by checking here, I agree that I will submit a writtenopt-out request to info@blackmathcollective.org prior to the start of the program. Myfailure to timely submit an opt-out request shall serve as my consent.
Emergency Medical Consent: I authorize BMC Parties to administer first aid and, if necessary, seek emergency medicalcare for my child in the event of an injury during program activities.
Field Trips: I understand that my child cannot participate in off-site activities unless I first execute aseparate permission form provided by BMC Parties.
Behavioral Expectations: I understand that I will be notified if my child’s behavior interferes with the programsoffered by BMC Parties. Further disciplinary problems may result in expulsion from theprogram.
Pick-Up Responsibility: I am responsible for ensuring my child is picked up promptly at the conclusion of eachscheduled program, event, meeting, or class, or session hosted by BMC Parties.
No Liability: I acknowledge and agree that BMC Parties are not liable for any injury or harm that maybefall my child while traveling to or from any program, event, meeting, class or sessionhosted by BMC Parties.
Arbitration/Mediation Agreement: I agree that any dispute related to this agreement or my child’s participation in programsoffered by BMC Parties will be resolved through final and binding arbitration withJAMS, rather than in court. I understand that this means giving up the right to a trial byjudge or jury. Before beginning arbitration, the parties agree to first attempt to resolveany dispute through good faith mediation administered by JAMS. If mediation does notresolve the dispute, it will be submitted to final and binding arbitration under the JAMSStreamlined Arbitration Rules. All disputes shall be governed by California law.
Signature & Date
Date
*
-
Month
-
Day
Year
Date
Signature
*
Membership Options
Choose either BMC Basic via Credit card OR BMC basic via Zelle. If you cannot afford the membership, please go down to Financial Assistance Request section
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BMC Basic - Annual – $165 (One-time) via Credit card
$
165.00
for each
year
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
BMC Basic - Annual – $150 (One-time) via Zelle
$150.00 for each year
Financial Assistance Request
I am unable to afford the $165 membership and would like to apply for financial assistance.
IF APPLICABLE* Please write your City of Residence below
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