Van Arsdale Elementary School | Summit School of Chess

Day and Time: Tuesdays after school from 2:35-3:35 PM

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

Location: Classroom/Art/Library TBD

Terms: A full refund will be given to any request AT LEAST one week prior to the start of the 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) – Aug 29th, Sept 5th, 12th, 19th, 26th, Oct 3rd, 10th, 17th, 24th – $108

Session 2 (9 weeks) Oct 31st, Nov 7th 14th, 28th, Dec 5th, 12th, 19th, Jan 9th, 16th – $108

Session 3 (9 weeks) - Jan 23rd, 30th, Feb 6th, 13th, 20th, 27th, March 5th, 12th, 26th – $108

Session 4 ( 9 weeks) - April 2nd 9th, 16th, 23rd, 30th, May 2nd, 9th, 16th, – $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 Van Arsdale Elementary School’s code of conduct.