OrthoChess - After School Programs Registration

Chess Student's Information

Please complete your registration and submit your payment via Paypal.

Student’s School Name:

Student’s Name:

Student’s Grade - August 2018:

Student’s Chess Level?

Beginner Intermediate Advanced

Chess Program:

Winter/Spring Semester 2018 Fall/Winter Semester 2018

Student’s Chess Rating (if any and experience, in your own words):

Parent's Name:

Email:

Emergency Contact Phone:

Student’s Health Condition or Allergies:

reload

Enter the code from the image here:

After registration above is completed, please proceed with payment via Paypal. Thank you!