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Chess After School Club Registration Form

2:30-3:30pm - Tuesdays starting 12/2
8 week session - Tuesdays starting 12/2 - dates are 12/2, 12/9, 12/16, 1/6, 1/13, 1/20, 1/27 and 2/3
Program fee $240

Please complete the form below to SignUp

Required fields marked with an asterisk *

Student Information

Student's First Name*

Answer required for "Student's First Name"

Student's Last Name

Answer required for "Student's Last Name"

Student's Grade*

Answer required for "Student's Grade"

Parent Information

Full Name*

Answer required for "Full Name"

Phone Number*

xxx-xxx-xxxx

Number Required

Pickup Person Full Name*

Answer required for "Pickup Person Full Name"

Relationship to the student being pickedup*

Answer required for "Relationship to the student being pickedup"

Fee*

8 weeks program

Answer required for "Fee"

$240.00

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"