PALS Chess Club - Winter/Spring Session

Montessori Peaks Academy

Chess Club Registration Form

Day and Time: Thursdays after school from 3:15 - 4.15 p.m.

Winter/Spring Session Dates:

1/27, 2/3, 2/10, 2/17, 2/24, 3/3, 3/10, 3/31, 4/7, 4/14, 4/21, 4/28, 5/5, 5/12

No club days: 3/17, 3/24

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

Registration: *

Winter/Spring Session (14 classes): update

Starting on 3/10 (prorated for 8 classes): $108

Sibling Registration

Winter/Spring Session (14 classes): $378

registration for the testing: *

participant one test:'$100

sibling test: $100

Processing fee: *

Current Total:

$0.00

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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.