Childs Name: *

Parents Name:

Phone *

E-Mail *

Address

Grade *

School *

My Child will play in section: *

My child, (named above) is permitted to participate in this event. I fully understand that it is my responsibility to supervise/arrange supervision for my child during this event. Should it be necessary for my child to have emergency medical treatment while participating in this event, I hereby give permission to render medical treatment deemed necessary. I, release, discharge, indemnify, and hold harmless the TCAMA, River Islands Technology Academy and any their volunteers and/or staff, from any claims relating to any injury that may result to my child while participating in this event. I give my permission for people to take and use photographs, or any other recorded material, taken during this chess tournament. I consent to the publication of this child’s individual tournament results/scores. *