PALS Chess Club - Fall Session 2023

American Academy

Motsenbocker

Chess Club Registration Form

Day and Time: Mondays after school from 3:45 – 4:45 p.m. in Room 121

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

Open to grades K-8: Students will be paired according to grade and level.

Participant Information

First Name *

Last Name *

Grade *

Birthday 🛈 +

Level of Experience *

Register a second child?

Yes

First Name *

Last Name *

Grade *

Birthday * 🛈 +

Level of Experience *

Register a third child?

Yes

First Name *

Last Name *

Grade *

Birthday * 🛈 +

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

Please email me updates about my child's chess club, upcoming tournaments, and more chess-related news!

Registration *

12 week Session: $192

Sibling registration *

12 week Session for two children: $384

Sibling registration (three children) *

12 week session for three children: $576

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.