Chess Registration
Chess Registration
$
0
Total
Child's Name
Child's Name
*
First
Last
Grade
1
2
3
4
5
6
7
8
List any allergies and medications
Parent's Name
Parent's Name
First
Last
Parent's Phone Number
Parent's Phone Number
*
-
###
-
###
####
Parent's Email Address
*
A confirmation of this registration will be sent to this e-mail address.
Is Parent an Academy Employee?
Is Parent an Academy Employee?
Yes
No
Emergency Contact
Emergency Contact
First
Last
Emergency Contact Phone Number
Emergency Contact Phone Number
-
###
-
###
####
After clicking Submit below, please wait to be redirected to online payment.
$120
$
Dollars
.
Cents
$
0
Total