PALS Chess Club - Spring Session 2023

Heritage Elementary School

Chess Club Registration Form

Day and Time: Thursdays after school from 2:45 - 3:45 in the Library

Spring Session: 2/2, 2/9, 2/16, 2/23, 3/9, 3/16, 3/30, 4/6, 4/13, 4/20, 4/27, 5/4

Open to grades K-5: After each weekly lesson, students will be paired according to age and level.

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 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

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

Registration: *

Spring Session: $192

Sibling Registration: *

Spring Session for two children: $384

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.