Coyote Ridge Elementary

Day and Time: Thursdays after school from 2:40 - 3:40 PM

Cost and duration: $12 per class per session (e.g. $120 for an 10 week session)

Location: Classroom TBD

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

Fall Session (10 weeks) –Sept 14th, 21st, 28th, Oct 12th, 26th, Nov 2nd, 9th, 16th, 30th Dec 7th – $120

Winter Session (10 weeks) – Dec 14th, 21st, Jan 11th, 18th, 25th, Feb 1st, 8th, 15th, 29th March 7th – $120

Spring Session (10 weeks) - March 14th, 21st 28th, April 11st, 18th, 25th, May 2nd, 9th, 16th, 23rd – $120

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 Coyote Ridge Elementary School’s code of conduct.