PALS Chess Club - Fall Session 2023

Platte River Academy

Chess Club Registration Form

Day and Time: Fridays after school from 3:30 – 4:30 p.m.

Fall session dates: 9/8, 9/15, 9/29, 10/27, 11/10, 11/17, 12/1, 12/8, 12/15

Grades K-8: Students will be paired based on age and prior experience

Participant Information

First Name *

Last Name *

Grade *

Register another child?

Yes

First Name *

Last Name *

Grade *

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 *

Email Address *

Phone number *

Zip Code *

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Registration: *

Fall (9 week) Session: $144

Sibling Registration: *

Fall Session (9 weeks) for two children: $288

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.