PALS Chess Club - Spring Session 2024

Prairie Crossing Elementary

Chess Club Registration Form

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

Session Dates: 1/22, 1/29, 2/5, 2/12, 2/26, 3/4, 3/11, 3/25, 4/1, 4/8, 4/15, 4/22, 4/29, 5/6

Who: Kindergarten to 6th grade

We welcome all levels! Coaches will teach beginning, intermediate, and advanced lessons.

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 *

Email Address *

Phone *

Alternate Phone

Zip *

Prairie Crossing Chess Club 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

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

Registration for the 14 week spring session: *

Participant: $224

Sibling: $224

Processing fee: *

Current Total:

$0.00

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.