PALS Chess Club - Spring Session

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: 2/6, 2/13, 2/27, 3/6, 3/20, 3/27, 4/3, 4/10, 4/17, 4/24, 5/1, 5/8

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 *

Spring Session: $192

Sibling registration *

Spring Session for two children: $384

Sibling registration (three children) *

Spring 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.