PALS Chess Club - Fall Session

Ralston Elementary School

PALS Chess Club Registration Form

Colorado State Champion Lior Lapid will teach all classes!

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

Fall Session: 9/11, 9/18, 9/25, 10/2, 10/9, 10/16, 10/23, 10/30, 11/6, 11/13, 11/27, 12/4

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 *

Fall Session: $144

Sibling Registration *

Fall Session for two students: $268, a $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