PALS Chess Club - Fall Session 2023

Our Lady of Lourdes

South Campus

Chess Club Registration Form

Spring Session Full Days: Fridays after school from 3:00-4:00 pm

1/19, 2/9, 2/16, 3/1, 4/12, 5/3

Spring Session Early Release: Fridays after school from 12:30-1:30 pm

3/15, 4/19, 5/10

Grades K-8th: Students will be paired based on age and prior experience

Participant Information

First Name *

Last Name *

Grade *

Level of chess experience *

Register a second child? ($20 sibling discount)

Yes

First Name *

Last Name *

Grade *

Level of chess experience *

Register a third child? ($40 sibling discount)

Yes

First Name *

Last Name *

Grade *

Level of chess experience for the 3rd child *

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 *

Zip Code *

Email Address *

Phone number *

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Our Lady of Lourdes South Campus Registration

By signing up for PALS Chess Academy LLC chess clubs, tournaments, or camps, the participant, (or parent/guardian if a minor), in this activity acknowledges the risks associated with the activity and agrees to hold PALS Chess Academy LLC, The McConnell family and any other employees or volunteers regarding chess clubs, tournaments, and camps harmless in the event of any damages or injury that may arise.

By providing this electronic signature and participating in, or authorizing participation in, PALS Chess Academy LLC chess clubs, tournaments, or camps in any way whatsoever, you hereby release and hold harmless forever PALS Chess Academy LLC, its instructors, employees, agents, and consultants from any and all liability, for any claim, demand, injury, expense, damage, action or cause of action arising out of or connected with the services or facilities of these entities, including those arising from acts of active or passive negligence.

Electronic Signature *

clear

Registration: *

Spring session: $144

Sibling Registration: *

Spring Session for two children ($20 sibling discount): $268

Sibling Registration: *

Spring Session for three children ($40 sibling discount): $392

Processing Fee: *

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.