Colorado STEM Academy | Summit School of Chess

Day and Time: Mondays after school from 1:50 PM to 2:50 PM

Cost and duration: $12 per student per class. (e.g. $108 for a 9 week session)

Location: TBD - classroom

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

School Program

Payment Item

Session 1 (9 weeks) Sept 11th, 25th, Oct 2nd, 9th, 23rd, 30th, Nov. 6th, 13th, 27th – $108

Session 2 (9 weeks) Dec 4th, 11th, 18th, Jan 8th, 22nd, 29th, 12th, 26th, March 4th – $108

Session 3 (9 weeks) March 11th, April 1st, 8th, 15th, 22nd, 29th, May 6th, 13th, 20th – $108

Total Cost:

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 Colorado STEM Academy’s code of conduct.