chess kids ny camps registration form

       
 
Student Name:
Age:
School:
  
 
Contact Name:
Contact Phone number:
Emergency number:
  
 
Address:
City:
State:
  
 
Zip Code:

E-mail:

  
   
SESSIONS
TIME
    
   
1st SESSION
Sep 19 - Jan 23

none
3-5 pm
5-6 pm
3-6 pm

   
   
2nd Session
Jan 30 - March 20
none
3-4:30 pm
4:30-6 pm
3-6 pm
   
   
3rd Session
April 3rd- June 19th

none
3-5:00 pm
5:00-6 pm
4:30-6 pm
3-4:30 pm

   
 
Please describe health problems e.g. allergies, asthma, or medications if any,
or, if you have any comments :
 
   

 

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