Hulstrom K-8 After School Program: Join Us on Mondays!

Day and Time: Wednesdays after school from 3:40-4:40 PM

Cost and duration: $15 per class (i.e. a 8-week session will cost $120)

Location: Classroom TBA

Terms: A full refund will be given to any request AT LEAST one week prior to the beginning of session.

Please fill out the form below to register.

Participant Information:

First name

Last name

Grade

D.O.B

GUARDIAN INFORMATION

First name

Last Name

Phone #

Address

Address line 2

City

State

Zip Code

Registration Cost

Payment Item

Fall Session (8 weeks) - 9/18, 9/25, 10/02, 10/09, 11/06, 11/13, 11/20, 12/04 with no classes held on 10/16, 10/23, 10/30, 11/27 – $120

Winter Session (8 weeks) – 12/11, 12/18, 1/08, 1/15, 1/22, 1/29, 2/05, 2/12 with no classes held on 12/25, 1/01 – $120

Spring Session (8 weeks) – 2/26, 3/05, 3/26, 4/09, 4/16, 4/23, 4/30, 5/07 with no classes held on 3/12, 3/19, 4/02 – $120

Total Cost:

School Program

Terms

Emergency Medical Consent

In the event of an emergency requiring medical attention for my child, I understand that Summit School of Chess instructors will make every effort to contact me. However, if I cannot be reached, I give permission for a licensed physician or medical treatment center to administer emergency medical care if needed.

Electronic Signature

By providing this signature and participating in, or authorizing participation in, this Summit School of Chess after school chess enrichment in any way whatsoever, you hereby release and hold harmless forever Summit School of Chess, its instructors, employees, agents, and consultants from any and all liability, for any claim, demand, injury, expense, damage, action or cause of action arising out of or connected with the services or facilities of these entities, including those arising from acts of active or passive negligence. All participants, guardians and observers must comply with Holstrom K-8 School’s code of conduct.