PALS Chess Club - Fall Session

Drake Middle School

Chess Club Registration Form

When: All Drake enrichment programs have been moved to before school.

Chess club will be Monday before school 7:45-8:45

Fall Session: 9/11, 9/18, 9/25, 10/ 2, 10/9, 10/16, 10/23, 10/30, 11/6, 11/27, 12/4

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 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 *

Phone *

Alternate Phone

Email Address *

Registration *

Fall session: $176

Sibling Registration *

Fall session for two children: $352

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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.