PALS Chess Club - Fall Session 2023

Leman Academy

of Excellence

Chess Club Registration Form

When: Wednesdays before school from 7:30 - 8:30 a.m.

Fall dates: 9/13, 9/20, 9/27, 10/4, 10/11, 10/25, 11/1, 11/8, 11/15, 11/29, 12/6, 12/13, 12/20

Open to grades K-8: 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 a second child?

Yes

First Name *

Last Name *

Grade *

Student's Birthday * 🛈 +

Level of Experience *

Register a third child?

Yes

First Name *

Last Name *

Grade *

Student's Birthday * 🛈 +

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 after chess club.

Level of Experience *

Does your child have any medical issues or allergies that we should be aware of? *

Adult Primary Contact

Relationship to Participants: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Email Address *

Phone *

Alternate Phone

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

Registration: *

Fall Session (13 weeks): $195

Registration Options: *

Fall Session for two children (13 weeks): $390

Registration Options: *

Fall Session for three children (13 weeks): $585

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.