PALS Chess Club - Fall Session 2023

Holm Elementary School

Chess Club Registration Form

Day and Time: Fridays after school from 2:30 - 3:30

Fall Session: 9/8, 9/15, 9/29, 10/6, 10/20, 10/27, 11/3, 11/10, 11/17, 12/1, 12/8, 12/15

Open to 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

Level of Experience

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 following chess club.

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

Registration *

Fall Session (12 weeks): $144

Sibling Registration *

Fall Session (12 weeks) for two students: $288

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.