PALS Chess Club - Spring 2022

Eldorado Elementary

Chess Club Registration Form

Day and Time: Tuesdays before school from 7:30 - 8:30 a.m.

Spring Session: 2/7, 2/14, 2/21, 2/28, 3/7, 3/21, 3/28, 4/4, 4/11, 4/18, 4/25, 5/2

Open to grades K-6: 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 *

Register a second child?

Yes

First Name

Last Name

Student's Birthday 🛈 +

Grade

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 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 *

Address 1 *

Address 2

City *

State *

Zip *

Email Address *

Phone *

Alternate Phone

Registration *

Spring Session: $192

Sibling Registration *

Spring Session for two children: $384

Sign up for the PALS newsletter for updates about chess club, tournaments, events and special offers!

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.