Panda Chess Academy Registration Form
Please make payment before filling out this form. Zelle/PayPal/Venmo: jeffreyashton@gmail.com and please double-check the spelling. 
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Email *
What are you registering for? Please check all that apply. *
Required
Student's Name *
Phone *
Please list the best phone number for us to reach you. 
Birthday *
MM
/
DD
/
YYYY
School *
Grade *
Name of Parent or Guardian
Additional Parent or Guardian
Mailing Address *
Additional Phone
Additional phone number. If you wish to enter more, you may do so in the "Notes and Other Information" part of this form. 
Please list any emergency contact information. 
Example: Jane Doe, Child's Grandma, 214-333-4444 123 Smith St Houston TX 77025
Please list any food allergies or medical conditions of which we should be aware.
How did you hear about the Panda Chess Academy?
Notes and Other Information
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