PALS Chess Club - Spring Session 2022

Creekside Elementary School

Chess Club Registration Form

Day and Time: Tuesday afternoons from 2:45 to 3:45 p.m.

Spring Session: 1/24, 1/31, 2/7, 2/14, 3/7, 3/14, 3/28, 4/4, 4/11, 4/18, 4/25, 5/2

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

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 after chess club.

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 *

Email Address *

Phone

Alternate Phone

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.