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Chess Club Registration Form

****Chess is only open to those students who participated last year or in the fall. No new
students will be allowed at this time****

Students Name: _____________________________________________________________


Grade: ______________ (Grades 2 through 8 )
Parent Name: _______________________________________________________________
Parent Email: ________________________________________________________________
Parent Phone #: ______________________________________________________________
______ I am willing to volunteer as a chaperone at one or more of the Chess Club sessions.
Students Chess Experience: ____________________________________________________
____________________________________________________________________________
*Cost of Chess Club Registration: $40
*Please make checks out to St. Ann School and put Chess Club in the memo section!

--------------------------------------------------------------Chess Club Dismissal Form


I give permission for my child, ___________________________________________, to be dismissed to
the Chess Club on each day it meets. (Mondays February through May)
Parent Signature: ________________________________________________
_________ My child will go to Extended Day after Chess Club.
_________ My child will be picked up at the end of Chess Club.

*Please return the entire form completed in full to St. Ann School along with your payment of $40.

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