Fraser Heights Chess Club: Registration Form
Fraser Heights Chess Club: Registration Form
Fraser Heights Chess Club: Registration Form
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
____________________ Date