PALS Chess Club - Fall Sesson 2023

Fox Creek Elementary

Chess Club Registration Form

Day and Time: Monday afternoons from 3:30 to 4:30 p.m.

Fall Session: 9/11, 9/18, 9/25, 10/2, 10/23, 10/30, 11/6, 11/13, 11/27, 12/4, 12/11, 12/18

Open to grades K-6th: 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

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 *

Phone *

Email Address *

Zip *

Alternate Phone

Registration *

Fall (12 week ) Session: $192

Sibling Registration *

Fall (12 week) session for two students: $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.