2017 BEAR – FALL CHESS ENROLLMENT FORM Start Date: Wednesday, SEP 6th Caesar Chess, LLC Caesar Lawrence – Director 5184 Caldwell Mill Road, Suite 204 - 202 Birmingham, AL 35244 * Phone: (334) 868-0271
Email:
[email protected] / Facebook: Caesar Chess The Benefits of Chess Class... Chess is proven as an excellent way to develop the cognitive abilities of children. Things like planning, attention to details, critical thinking, analysis, focus; problem solving, pattern recognition, confidence, time management, and discipline are [all] developed through chess practice. Bear Exploration Center * 2525 Churchill Drive * Montgomery, AL 36111 Site: Activity Room Day: Wednesday Time: 3:45pm til 4:45pm ( 1 hour class ) Child’s Name: _______________________________ Age____ Grade____ Male/Female_______ Mom’s Name: __________________________ Cell #_______________ Work #______________ Dad’s Name: ___________________________ Cell #_______________ Work #______________ Address: _________________________________ City: ______________ ST: ___ Zip: ________ Parent’s Email*: ____________________________*Email used for Caesar Chess purposes only.
REGISTRATION INFORMATION: ** SEPTEMBER 2017 Fall Enrollment Form ** •The chess school year is divided into two semesters – Fall & Winter. Grades: 2nd thru 5th. • Fall Semester Chess Class Tuition is $50/Month. Plus, a one-time $20 fee for chess supplies. •Registration is Open Now. ** Email this form ASAP to:
[email protected] •Scholastic Chess Tournament (2+) participation is strongly encouraged and recommended. •Make the check payable to: Caesar Chess. Mail enrollment form and payment check to:
Caesar Chess LLC, 5184 Caldwell Mill Road, Suite 204 - 202, Birmingham, AL 35244
** Other Relatives and/or Friends who can pick up your child from the Caesar Chess Class: Name: ___________________________ Ph #__________ Cell__________ Relationship_________ Name: ___________________________ Ph #__________ Cell__________ Relationship_________
PARENTAL CONSENT Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement. I, the minor’s parent and/or legal guardian, understand the nature of chess activities and events, and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activities. I hereby Release, Discharge, and Covenant not to sue Caesar Chess, its instructors, agents, volunteers, contractors, and other participants, any sponsors, advertisers, local, state and national affiliated organizations, and, if applicable, owners, lessors and/or custodians of premises on which the activities takes place (each considered one of the “RELEASES” herein). I AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the RELEASES from all liability, claims, demands, losses, damages, or costs, on my account caused or alleged to be caused in whole or in part by the Releases, which may arise in any manner or form from my child’s participation in this program. I also consent to allow my child’s photo to be used in promotion and advertising materials of Caesar Chess.
___________________________________________ Printed Name of Parent and/or Legal Guardian _____________________________________ Signature of Parent and/or Legal Guardian
Date: ________________
AUG 2017
