PALS Chess Club - Fall Session 2023

Aspen Academy

(Grades 5-8)

Chess Club Registration Form

Day and Time: Friday afternoons from 3:25 - 4:25

Fall Session: 9/8, 9/15, 9/22*,9/29, 10/13, 10/20, 10/27*, 11/3, 11/10, 11/17*, 12/1, 12/8, 12/15

* Dates marked with an asterisk are early-dismissal days with chess club meeting from 11:25-12:25

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 after chess club.

Level of Experience

Does your child have any allergies or medical conditions? If so, please list them below:

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

PALS Chess Academy will only contact you in the event of an emergency or if parents are late picking up their kids. We will not contact you for marketing purposes.

Registration *

Fall Session (13 weeks): $234

Sibling Registration *

Fall Session for two children (13 weeks): $468

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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.