The Benjamin School
Please fill in your details in the form below and complete payment via the PayPal link to be automatically registered for your school's chess program.

Payment Information:

- All parents must register their students online using this form before the start of the first club.

- Payment needs to be made during registration or the registration form will be considered invalid.

- Full payment is required before the start of the first club

- Parents of Title 1 students and students who receive free and reduced lunch may email to inquire about other payment options.
Student Full Name *
Current Grade *
Parent/Guardian Full Name *
Parent/Guardian Email Address
Primary Emergency Contact Number *
Secondary Emergency Contact Number *
If Applicable: Please list any health or social information we need to know about your child. Examples include diagnosed allergies or health conditions.
Does your child have a USCF (United States Chess Federation) rating and if so, what is it? *
Which Session are you registering your child for? *
Terms of Service *
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