PALS Chess Club - 2023 Spring Session

Good Shepherd

Catholic School

Chess Club Registration Form

Day and Time: Mondays after school from 3:15 - 4:15 p.m.

Spring Session: 4/3, 4/17, 4/24, 5/1, 5/8, 5/15, 5/22

Open to grades K-5. After each weekly lesson, students will be paired according to age and level.

Participant Information

First Name *

Last Name *

Grade *

Student's Birthday * 🛈 +

Level of Experience *

Register another child?

Yes

First Name *

Last Name *

Grade *

Student's Birthday * 🛈 +

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 Options: *

Spring Session (prorated for students starting on 4/3): $128

Sibling Registration: *

Spring Session, two students (prorated for students starting on 4/3): $256

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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.