PALS Chess Club - Spring Session

Platte River Academy

Chess Club Registration Form

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

Spring Session Dates: 2/10, 2/24, 3/10, 3/24, 3/31, 4/14, 4/28, 5/5, 5/12

Note: due to school policy, there will be no club on early dismissal days

Grades K-5: 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 *

Address *

City *

State *

Zip Code *

Email Address *

Phone number *

Sign up for the free PALS newsletter for updates about chess club, tournaments, events and special offers!

Registration: *

Spring Session (prorated): $142

Sibling Registration: *

Spring Session for two children: $300

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.