Shelton Elementary School
Chess Club Registration Form

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

Session Dates:  2-5, 2-12, 2-26, 3-5, 3-12, 3-19, 4-2

Participant Information

Register another child?

Household / Adult Primary Contact

Relationship to Participants: *
Registration Options: *
Registration Options: *
Emergency Medical Consent: *
Photo Release

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 I understand that my child’s name will not be published on the Internet.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