PALS Chess Club - Fall Session

Challenge School

Chess Club Registration Form

Day and Time: Wednesdays after school from 1:50 - 2:50 pm

Session dates: 8/23, 8/30 9/6, 9/13, 9/20, 9/27, 10/4, 10/11, 10/25, 11/1, 11/8, 11/15, 11/29, 12/6, 12/13, 12/20

Grades K-4: Beginners are welcome to join! Students will be paired based on age and experience. Coaches will teach separate lessons for the beginner, intermediate, and advanced groups.

Participant Information

First Name *

Last Name *

Grade *

Student's Birthday 🛈 +

Level of Experience *

Register a second child?

Yes

First Name

Last Name

Grade

Student's Birthday 🛈 +

Level of Experience

Does your child need to return to the school's aftercare program following chess club? *

Yes, please take my child to the school's aftercare program following chess club.

No, my child will be picked up by a designated adult following chess club.

Does your child take the bus home after chess club? (if so, one of the coaches or parent volunteers will walk your child to the bus a few minutes before 3:00) *

Yes

No

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 *

Zip Code *

Email Address *

Phone *

Alternate Phone

Registration: *

Fall Session (16 weeks): $228

Oops I paid for 14 weeks & need to pay for 2 more! $28

Sibling Registration

Fall session for two children (16 weeks): $456

Oops I paid for 14 weeks & need to pay for 2 more for 2 kiddos! $56

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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.