Polaris at Ebert Elementary
Chess Club Registration Form

Day and Time:  Thursdays after school from 3:30 - 4:30 p.m.

Spring 2018 Session Dates:  1-25, 2-1, 2-8, 2-15, 2-22, 3-1, 3-8, 3-15, 3-22, 4-5, 4-12, 4-19, 4-26, 5-3, 5-10


Participant Information

Register a second child?

Household / Adult Primary Contact

Relationship to Participants: *
Registration Options: *
Registration Options: *
Optional (for additional practice at home) *
Photo Consent

I give permission for photos of my child, captured during regular chess camp activities, to be used solely in news stories, the PALS website, our e-newsletter, and/or other promotional materials. I understand that my child’s name will not be published on the Internet.  I may revoke my consent at any time by sending an e-mail to lior@palschess.com

Emergency Medical Consent: *