PALS Chess Club - Fall Session 2023

Mountain View Elementary

Chess Club Registration Form

Day and Time: Mondays after school from 3:40 - 4:40 p.m.

Fall Session: 9/11, 9/18, 9/25, 10/2, 10/9, 10/16, 10/23, 10/30, 11/6, 11/13, 11/27, 12/4, 12/11

Grades K-5: 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 *

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 following chess club.

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

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 *

Zip *

Email Address *

Phone *

Alternate Phone

Registration *

Fall (13 week) session: $208

Sibling Registration *

Fall (13 week) session for two children: $416

Sign up for the free 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.