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Chess Camp #1 - 2019
Messiah Lutheran Classical Academy
1308 Whitley Road
Keller Texas, 76248

June 24-29, 2019
1pm - 4pm

Email address *
Participant's First Name *
First Name
Your answer
Participant's Last Name *
Last Name
Your answer
Gender *
Grade entering this Fall *
What school does the student attend? *
Your answer
How did you hear about our chess camp?
Your answer
Chess Experience *
Please describe this participant's experience with and knowledge of chess.
T Shirt Size: *
Parent First Name *
Your answer
Parent Last Name *
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Primary Phone Number *
Your answer
Other Phone Number
Your answer
Emergency Contact *
First and Last Name
Your answer
Emergency Contact Phone *
Your answer
Alternate Pickup
First and Last Name
Your answer
Alternate Pickup Phone
Your answer
Permission to Attend *
I give permission for my child (named above) to attend Chess Camp at Messiah Lutheran Classical Academy as listed above. I understand that the information I give for this registration will only be used by Messiah Lutheran Classical Academy.
Required
General Information
Your answer
Medical Issues or Special Needs
Your answer
Medical Release *
I give my permission for the Chess Camp staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the Chess Camp staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Required
Photo Release *
I hereby grant Messiah Lutheran Classical Academy permission to copyright and use photographs/videos taken at Chess Camp of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Required
Payment *
I understand that this registration is complete and my student's place is reserved only when $30 payment is submitted through PayPal or Vanco at one of the links provided.
Required
Learn More about MLCA? *
A copy of your responses will be emailed to the address you provided.
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