PALS Chess Club - Fall Session 2023

Our Lady of Lourdes

North Campus

Chess Club Registration Form

Fall Session Full Days: Fridays after school from 3:00-4:00 pm

9/8, 9/15, 10/13, 11/3, 11/17

Fall Session Early Release: Fridays after school from 12:30-1:30 pm

9/22, 10/6, 11/10

Grades K-8th: Students will be paired based on age and prior experience

Participant Information

First Name *

Last Name *

Grade *

Register another child? ($20 sibling discount)

Yes

First Name *

Last Name *

Grade *

Register another child? ($40 sibling discount)

Yes

First Name *

Last Name *

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 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 *

Zip Code *

Email Address *

Phone number *

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Registration: *

Fall (1st trimester) session: $128

Sibling Registration: *

Fall (1st trimester) Session for two children ($20-sibling discount): $236

Sibling Registration: *

Fall (1st trimester) Session for three children ($40-sibling discount): $344

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.