PALS Chess Club - Spring Session

Prairie Crossing Elementary

Chess Club Registration Form

Day and Time: Mondays after school from 3:35 - 4:35 p.m.

Spring Session: 1/30, 2/6, 2/13, 2/27, 3/6, 3/20, 3/27, 4/3, 4/10, 4/17

Open to grades 1-6: 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 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 (prorated): $144

Sibling Registration *

Spring Session for Two Children (prorated): $288

Yes, email me updates about my child's chess club, upcoming tournaments, and more chess-related news!

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.