Wiley Chess Club Sign Up
Parents: Please fill out all information on this form and then hit "Submit" at the bottom.  You will receive an email from VP of Communications within 24 hours of submission confirming your child's spot in the club.  After receipt of that email, you will be directed to the Chess website for payment options.  

The club will be limited to the first 24 students who sign up.  This form holds your place in Chess Club.

Need-based financial aid is available.  If interested, please fill out and submit this form and then contact vp.communications@wileypta.org for more information.

Please be aware that parents are expected to volunteer once every club session.


Meeting dates: Fridays (full school days only) from 4/10/15-6/5/15
Club time: 3:45-4:45
Club location: art room
Club cost: $110
Pick-up instructions: parents will need to show a green walker's card, yellow carpool card, or photo ID for people listed on this registration form

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Student Name *
Grade *
Teacher's Name *
Parent/Guardian 1 Name *
Parent/Guardian 1 Home Phone
Parent/Guardian 1 Work Phone
Parent/Guardian 1 Cell Phone *
Parent/Guardian 1 Email *
Parent/Guardian 2 Name *
or Emergency Contact
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Work Phone
Parent/Guardian 2 Cell Phone *
Parent/Guardian 2 Email *
Is the student alergic to anything? If YES, please list. *
Are there any medical issues that we need to be aware of? If Yes, please explain. *
Does your child attend YMCA After School? *
If your child should be released to the YMCA After School program after club, check yes.
Required
Other than the people listed on this form, is there anyone else who is allowed to pick-up your child?
As his/her parent or guardian, I give permission for my child to participate in the Chess Club at Wiley Elementary. *
This is your "signature" agreeing to your child's participation in the club, please type your full name.
Submit
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