PALS Chess Club - Fall Session 2023

Littleton Academy Chess Club

Chess Club Registration Form

Day and Time: Wednesdays before school from 7:00 - 8:00 a.m.

Fall Session: 9/20, 9/27, 10/4, 10/11, 10/25, 11/1, 11/8, 11/15, 11/29, 12/6

Kindergarten through 8th grade are all welcome to join!

*After each weekly lesson, students will be paired according to age and level.

Participant Information

First Name *

Last Name *

Student's Birthday * 🛈 +

Grade *

Level of Experience *

Does your child have any medical issues or allergies that we should be aware of? *

Register a second child?

Yes

First Name *

Last Name *

Student's Birthday * 🛈 +

Grade *

Level of Experience *

Does your child have any medical issues or allergies that we should be aware of? *

Register a third child?

Yes

First Name *

Last Name *

Student's Birthday * 🛈 +

Grade *

Level of Experience *

Does your child have any medical issues or allergies that we should be aware of? *

Household / Adult Primary Contact

Relationship to Participants: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Email Address *

Zip *

Phone *

Alternate Phone

Registration *

Fall (10 week) Session: $160

Sibling Registration *

Fall (10 weeks) session for siblings: $320

Sibling Registration *

Fall (10 week) Session for three children: $480

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Emergency Medical Consent: *

In the event of an emergency requiring medical attention for my child, I understand that PALS Chess instructors will make every effort to contact me. However, if I cannot be reached, I give permission for a licensed physician or medical treatment center to administer emergency medical care if needed.