PALS Chess Club - Fall Session 2023

Challenge School

Chess Club Registration Form

Day and Time: Fridays after school from 3:00 - 4:00 p.m

Fall Session: 9/8, 9/15, 9/29, 10/6, 10/27, 11/10, 11/17, 12/1, 12/8, 12/15

Grades 5-8: Beginners are welcome to join! Students will be paired based on age and experience.

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.

Sometimes my child will need to be taken to the school's aftercare 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: *

Fall Session (10 weeks): $144

Sibling Registration

Fall Session (10 weeks): $288

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.