Chess for Success Online Club Registration 6-12th grade
We are pleased to once again offer an online version of our club for students who are not able to attend the club at their school. This club is open to all students in Oregon and Washington. 

We will meet once a week on Saturdays from 10am-12pm over zoom.

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Student first and last name *
Grade level  *
School student attends  *
Student Gender *
Pronouns *
Race *
Ethnicity *
Parent or Guardian Name *
Parent or guardian email *
Parent or Guardian phone number  *
T-shirt size  *
Chess level 
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Chess for Success PHOTO/VIDEO RELEASE FORM

I hereby grant Chess for Success permission to use my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of Chess for Success and will not be returned.

I hereby irrevocably authorize Chess for Success to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge Chess for Success from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE AND I AFFIRM I AM THE LEGAL GUARDIAN FOR THE REGISTERED STUDENT AND GRANT CHESS FOR SUCCESS PERMISSION TO TAKE AND USE PHOTOS OF MY STUDENT
Please be on the lookout for an email confirming your registration from info@chessforsuccess.org or patty@chessforsuccess.org that will also contain your zoom class link. If you have not received an email, your registration is not confirmed. These are done manually with only 14 spots available. Please give us 24-48 business hours to respond after you complete the form.
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