PALS Chess Club - Spring Session 2024

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: 1/22, 1/29, 2/5, 2/12, 2/26, 3/4, 3/11, 3/25, 4/1, 4/8, 4/15, 4/22, 4/29, 5/6, 5/13

Open to grades 1-8: 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 *

Email Address *

Zip *

Phone *

Alternate Phone

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

American Academy Motsenbocker Registration

By signing up for PALS Chess Academy LLC chess clubs, tournaments, or camps, the participant, (or parent/guardian if a minor), in this activity acknowledges the risks associated with the activity and agrees to hold PALS Chess Academy LLC, The McConnell family and any other employees or volunteers regarding chess clubs, tournaments, and camps harmless in the event of any damages or injury that may arise.

By providing this electronic signature and participating in, or authorizing participation in, PALS Chess Academy LLC chess clubs, tournaments, or camps in any way whatsoever, you hereby release and hold harmless forever PALS Chess Academy LLC, its instructors, employees, agents, and consultants from any and all liability, for any claim, demand, injury, expense, damage, action or cause of action arising out of or connected with the services or facilities of these entities, including those arising from acts of active or passive negligence.

Electronic Signature *

clear

Registration *

15 week Session: $240

Sibling registration *

15 week Session for two children: $480

Sibling registration (three children) *

15 week session for three children: $720.00

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.