PALS Chess Club - on homeroom fall 2023

Edison Elementary

Chess Club Registration Form

Day and Time: Tuesdays after school from 3:30 - 4:30 p.m.

Fall Session: 9/5, 9/12, 9/19, 9/26, 10/3, 10/17, 10/24, 10/31, 11/7, 11/14, 11/28, 12/5

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 *

Birthday * 🛈 +

Level of Experience *

Register another child?

Yes

First Name *

Last Name *

Grade *

Birthday * 🛈 +

Level of Experience *

Who is your child's teacher? *

If registering a second child, who is your child's teacher?

Does your child need to go to the school's aftercare program following chess club? *

No, my child will be picked up by a designated adult following chess club.

Yes, please take my child to the school's aftercare program 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 *

Alternate Phone (optional)

Registration *

Fall Session (12weeks): $192

Sibling Registration *

Fall Session for two students (12weeks): $384

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

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.