Peabody Chess Club Registration
The Peabody Chess Club will meet weekly on Mondays from 2:30 - 4:00 p.m. Fees are as follows:
-FREE for students who attend after-care at least one day every week
-$70 per semester for students NOT in after-care and not in another Monday afternoon Peabody club
-$40 per semester for students NOT in after-care, but who ARE in another Monday afternoon Peabody club

Checks should be made payable to "Greater Memphis Chess Center" (write your student's name in the memo line) and given to Coach Mark at chess club -- he will provide a receipt. Payment can be made in monthly installments if paying the full amount is difficult. A very limited amount of financial assistance is available if payment is a hardship.
Parental Permission: *
I give permission for my child to attend the Peabody Chess Club after school on Mondays from 2:30 to 4:00. I understand that my child is to be picked up no later than 4:00 p.m. if I am not paying for After-Care on Mondays. Peabody After-Care students will be dismissed from Chess Club to the After-Care Staff. No child will be allowed to wait outside for his/her ride. Peabody After-Care Program will not be responsible for supervising my child unless he/she is enrolled in the After-Care Program. In case of emergency the chess club sponsor will contact my emergency contact or me immediately.
Student's Name *
Please submit a separate form for each student.
Student's Grade *
Will this student go to aftercare at 4:00 when club is over? *
Student's Teacher *
Student's Birthdate *
Example: 12/15/2003
Parent/Guardian Name *
Street Address *
City *
State *
Zip *
Phone Number *
Primary
Phone Number
Other
Parent/Guardian Email Address *
Emergency Contact Name *
Other than parent
Emergency Contact Number *
Payment *
Please submit payment to Principal Jones.
Submit
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