PALS Chess Club - Fall Session 2023

Lincoln Elementary

Chess Club Registration Form

Day and time: Tuesdays after school from 3:15 - 4:15 p.m.

Fall Session: 9/12, 9/19, 9/26, 10/3, 10/10, 10/17, 10/24, 10/31, 11/7, 11/14, 11/28, 12/5, 12/12

Open to grades K-5:

Students will be assigned to a beginner or intermediate class based on their age and prior experience

Participant Information

First Name *

Last Name *

Grade *

Student's Birthday 🛈 +

Level of Experience *

School teacher's name *

Register a second child?

Yes

First Name

Last Name

Grade

Student's Birthday 🛈 +

School teacher's name

Level of Experience

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 *

Address 1 *

Address 2

City *

State *

Zip *

Email Address *

Phone *

Alternate Phone (optional)

Registration: *

Fall Session (13 weeks): $208

Sibling Registration

Fall session (13 weeks) for two children: $416

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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.