PALS Chess Club - Spring Session 2023

Mountain Phoenix

Community School

Chess Club Registration Form

Day and Time: Fridays after school from 1:30 - 2:30 p.m.

Spring Session: 2/24, 3/3, 3/10, 3/17, 3/31, 4/7, 4/14, 4/21, 4/28, 5/5, 5/12, 5/19

Open to grades K-5: After each weekly lesson, students will be paired according to age and level.

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 *

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 1 *

Address 2

City *

State *

Zip *

Email Address *

Phone *

Alternate Phone

Registration: *

Spring Session: $192

Sibling Registration: *

Spring Session for two children: $384

Yes, 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.