PALS Chess Club - Fall Session 2023

Summit View Elementary

Chess Club Registration Form

Day and Time: Thursdays from 3:30-4:30pm

Session 1: 9/14, 9/21, 9/28, 10/5, 10/12 Session 2: 10/26, 11/2, 11/9, 11/16, 11/30, 12/7, 12/14

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

Participant Information

First Name *

Last Name *

Student's Birthday * 🛈 +

Grade *

Level of Experience *

Register a second child?

Yes

First Name *

Last Name *

Student's Birthday 🛈 +

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 following chess club.

No, my child will be picked up by a designated adult following chess club.

Level of Experience *

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

Session 1 Registration *

Fall session 1 (5 classes): $90

Fall session 2 (7 classes):$126

Both sessions (13 classes): $234

Sibling Registration *

Fall session 1: for two children: $180

Fall session 2: for two children: $252

Fall sessions 1 & 2 for two children: $432

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

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.