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CHESS CLASS TIMES AND LOCATIONS
** Classes start after Labor Day. Ten (10+) students needed for chess class to make! **
~ The chess class fee is $200/Fall 2023 Semester & $250/Spring 2024 Semester. ~
CHILD INFORMATION RECORD

Name(Required)
Hidden
Date of Admission

PERSONAL INFORMATION

Home Address

PRIMARY ACCOUNT HOLDER

Name
Home Address

MEDICAL INFORMATION

OTHER INFORMATION

EMERGENCY CONTACT & RELEASE OF CHILD

List of all individuals, including parents/ legal guardians, in order of preference, to be contacted in an emergency.
EMERGENCY
Name
Cell
Work
Home
 

RELEASE OF CHILD ONLY

List of all individuals, other than the parents/ legal guardians, to whom the child may be released.
RELEASE
Name
Cell
Work
Home
 
This field is for validation purposes and should be left unchanged.

10+ registered students are required for a class to be confirmed
Coach Caesar will send Confirmation via email