PALS Chess Club - Winter / Spring Session

Ralston Elementary School

Chess Club Registration Form

Colorado State Champion Lior Lapid will teach all classes!

Head Coach: National Master Lior Lapid

Day and Time: Tuesdays before school from 7:30 - 8:30 a.m.

Winter Session: 2-5, 2-12, 2-19, 2-26, 3-5, 3-12, 3-19

Spring Session: 4-2, 4-9, 4-16, 4-23, 4-30, 5-7, 5-14

Participant Information

First Name *

Last Name *

Grade *

Student's Birthday *

Level of Experience *

Register another child?

Yes

First Name *

Last Name *

Grade *

Student's Birthday *

Level of Experience *

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 *

Both sessions, 14 weeks: $180 (a $30 discount!)

Winter session, 7 weeks: $105

Spring session, 7 weeks: $105

Sibling Registration *

Both sessions, 14 weeks: $340, ($20 sibling discount and $60 two-session discount)

Winter session, 7 weeks: $190, ($20 sibling discount)

Spring session, 7 weeks: $190, ($20 sibling discount)

Please 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.

Photo Waiver (optional):

I give permission for photos of my child, captured during regular chess club activities, to be used solely in PALS promotional materials such as the website or e-newsletter. I understand that my child will not be identified by name unless I first give my express permission. I may revoke my consent at any time by emailing lior@palschess.com