Bradford Chess 2004-2005 Registration Form

Fill out areas below and Please Print Clearly

Player Information

First Name                                             Last Name                                                                                         

Street Address                                                              E-mail                                                                        

City _____________________________________________ State __________ ZIP Code_______________________

Sex ________ (M/F) Player’s Age___________ Birth date ______/_______/_______ (mm/dd/yy) Grade                  

Player Profile

·        Has the child played chess before? (Years) _________________  Rating?                                                  

·         All pupils in grades 2-12 are eligible for our evening program, which is scheduled for September 22- March 16 at School Street Elementary.  We will meet from 6:30 - 8:15 PM in the cafeteria.

Parent/Guardian Section

First Name                                                              Last Name                                                                        

Phone (        )                                                          E-mail                                                                              

I agree that my child can participate in the chess program and in the event of injury, I will not hold the Bradford Area Chess Boosters Club, The American Chess School, or the Bradford Area School District liable for any injuries.  I am willing to donate two hours or more to the chess program sometime this year.  As a participant, I promise to 1. follow directions the first time given; 2. pick up the chess equipment as soon as I am finished with it; 3. raise my hand before speaking; 4. not talk during chess games; 5. talk & walk quietly so I don't disturb others who are having lessons or playing games; 6. stay in the designated area.  I understand that if I break my promise I may be suspended depending upon the severity of the offense.  No refunds will be made for pupils who are suspended. 

______________________________________      ____________________________________

Parent/Guardian’s Signature (Required)                           Student's Signature       

* I would like to help coach.  I would prefer to work with  * beginners   * intermediates.

Registration Fees and Info

Registration will be at School Street Elementary on: Wednesday, September 22 and November 3 from 6:30 – 7:00 PM.  Classes will be scheduled for these evenings.

FEE SCHEDULE

_____ $52.00 for the entire program from September 22 - March 16.  BEST BUY—about $1 an hour!

_____ $16.00 for the six week League Warm-up from September 22 - October 27.

_____ $48.00 for participation in the Chess League from November 3 - March 16.

_____ $4.00 per week for participation in the program from September 22 - March 16.

TOTAL ENCLOSED _______________________________