PALS Chess Club - Spring Session 2022

Leman Academy

of Excellence

Chess Club Registration Form

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

Spring Session: 1/25, 2/1, 2/8, 2/15, 2/22, 3/1, 3/8, 3/22, 3/29, 4/5, 4/12, 4/19, 4/26, 5/3

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: *

Spring Session (Prorated - 13 weeks): $195

Registration Options: *

Spring Session (Prorated - 13 weeks) for two children: $390

Registration Options: *

Spring Session (Prorated - 13 weeks) for three children: $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.