PALS Chess Club - Spring Session

Drake Middle School

Chess Club Registration Form

Day and Time: Mondays after school from 2:30 - 3:30 p.m in room 212.

Spring Session: 2/13, 2/27, 3/6, 3/13, 3/27, 4/3, 4/10, 4/17, 4/24, 5/1, 5/8, 5/15

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 *

Spring session: $192

Sibling Registration *

Spring session for two children: $384

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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.