HOMESCHOOL & afterschool CHESS CLUB: BOULDER REGISTRATION PAGE REGISTRATION: BOULDER HOMESCHOOL & afterschool CHESS CLUB Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Boulder Homeschool/Afterschool Chess Club Where: George Reynolds Library 3595 Table Mesa Dr. Boulder, CO 80305 Day and Time: Fridays from 2:45-3:45pm Dates: 6/28, 7/12, 7/19, 7/26, 8/2, 8/9, 8/16, 8/23, 8/30, 9/6 Open to grades K-8 We welcome all beginner, intermediate and advanced chess players! Participant Information Student's Name *FirstLastStudent's Current Grade *KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeSchool? *Student's Birthdate *How did you hear about our program? *WebsiteTournamentSchoolFacebookInstagramColorado ParentCHECOtherLevel of ExperienceBeginner: Doesn't know how the pieces move.Intermediate: Knows how the pieces move and can play a full game.Advanced: Understands checkmate. 2+ years of playing experience.Does your child have any medical issues or allergies that we should be aware of? *Would you like to register another child? *YesNo; I will just register one child.Additional Participant Information Student's NameFirstLastStudent's Current GradeKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeSchool?Student's BirthdateLevel of ExperienceBeginner: Doesn't know how the pieces move.Intermediate: Knows how the pieces move and can play a full game.Advanced: Understands checkmate. 2+ years of playing experience.Does your child have any medical issues or allergies that we should be aware of?Household/Adult Primary Contact Relationship to participant *MotherFatherGuardianGrandparentOtherYour Name *FirstLastPhone *Alternative PhoneEmail *Zip Code *Email Opt-inPlease email me updates about chess camp, chess club, upcoming tournaments, and more chess-related news!Boulder Homeschool/Afterschool 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. Signature * Clear Signature Emergency Medical Consent In the event of an emergency requiring medical attention for my child/children, 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. Signature * Clear Signature Payment PALS Boulder Homeschool/Afterschool Chess Club What would you like to register for? *10 Week Summer Session: $186Drop In Only: $25Registering siblings? *10 Week Summer Session for 2 kiddos: $37210 Week Summer Session for 3 Kiddos: $558Drop in only 2 kiddos: $50Drop in only 3 kiddos: $75Sibling discount code: VTBU92DGDate of drop in: **n/a if you are signing up for the 10-week session* Enter coupon code here: Apply *Only one coupon allowed per form*Comments:Total$0.00Stripe Credit Card * Thank you for being part of our PALS family! Submit FollowFollowFollowFollow Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail Address *MessageSubmit
