William (Bill) Roberts K-8 School

Day and Time: Fridays after school from 12:45-1:45 PM.

Cost and duration: $14/class, (e.g. 140 per 10-week session)

Location: Classroom 136

Terms: A full refund will be given to any request ONE WEEK PRIOR to the beginning of a session. This gives us ample time to staff accordingly. Thanks for understanding!

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 29th, Oct 6th, 13th, 20th, 27th, Nov 3rd, 10th, 17th, Dec 1st, 8th – $140

Winter Session (10 weeks) – Dec 15th, Jan 5th, 12th, 19th, 26th, Feb 2nd, 9th, 16th, 23rd, March 1st – $140

Spring Session (10 weeks) - March 8th, 15th, 22nd, April 5th, 12th, 19th, 26th, May 3rd, 10th, 17th – $140

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 William (Bill) Roberts K-8 Schools’ code of conduct.