Fraser Heights Chess Club: Registration Form

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FRASER HEIGHTS CHESS CLUB

REGISTRATION FORM www.FraserHeightsChess.com


Every Friday, 6pm 7:30 pm - Please see schedule published on the website September 13th, 2013 - June 13, 2014 - Erma Stephenson Library Contact: Anca Datcu-Romano adatcu@qsoft.ca, 778 241-5842, 604 583-1395 The club will meet once a week for formal chess instruction and organized chess games. The group of coaches will direct the activity of the chess club and parent volunteers will assist with the club activities. Students must follow the code of conduct and pay the tuition fee in order to attend the sessions.

Please Print, fill in the information and Bring this form to the club the first session Student Section
Name: _______________________________________________________________________ Age ____ Grade _______ School ____________________________________________

Medical concerns______________________________________________________________ Do you know how to play chess? Do you want to play Yes No A little bit For fun Tournaments Yes

I have read and agree with the chess club code of conduct

Parent/Guardian Section
Name: _______________________________________________________________________ Email Address:_________________________________________________________________ Home Phone: ________________________ Work Phone: ______________________________ Cell Phone ___________________________ Other (emergency) ________________________ Liability disclaimer: Participants and parents of minor aged participants acknowledge they are aware of the nature of the activity, that there are inherent risks in any such activity, accept the risk of said activity and release Fraser Heights Chess Club from any and all claims for personal injuries and/or financial loss. Participants and parents of minor aged participants authorize coaches and supervisors of Fraser Heights Chess Club to seek medical treatment for the participant in the event of accident or emergency. Photos taken during programs may be used for promotional purposes and payment of fees and participation in this program shall constitute acceptance of this liability, medical and photographic release.

____________________________________ Student

____________________ Date

____________________________________ Parent or Guardian

____________________ Date

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