Platte River Academy Homeschool Chess Club

PRA Homeschool Chess Club Registration Form

SPRING SESSION 2024

Grades 4-8: Thursdays after school from 2:00 – 2:45 p.m.

Grades K-3: Thursdays after school from 2:45 – 3:30 p.m.*

Dates: 1/11, 1/18, 1/25, 2/1, 2/8, 2/15, 2/22, 2/29, 3/7, 3/14, 3/28, 4/11, 4/25, 5/2, 5/9

Students will be paired based on age and prior experience.

*Experienced K-3 players who know how the pieces move and understand basic strategy may opt to join the class for grades 4-8

Participant Information

First Name *

Last Name *

Grade *

Level of Chess Experience *

Register another child?

Yes

First Name *

Last Name *

Grade *

Level of Chess 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 *

Phone Number *

Zip Code *

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Registration Information

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: *

Spring Session K-3 Class (15 weeks): $240

Spring Session 4-8 Class (15 weeks): $240

Sibling Registration: *

Spring Session for two children, both in the K-3 class: $480

Spring Session for two children, both in the 4-8 class: $480

Spring Session for two children, one in each class: $480

Processing Fee: *

Current Total:

$0.00

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.