Winter Day Camp Enrollment Number of Campers:12345First Camper Name:*First Camper Gender: Boy Girl First Camper Birthday (xx/xx/xxxx): Month Day Year First Camper Grade:USCF Member? Yes No Join Now (White Kings – Top Section must be USCF members) If the child is not a current USCF member and he is enrolled in the Advanced Section, there will be an additional $20 charge to join the US Chess Federation. Players not in the advanced section do not need to join the USCF.USCF ID#:USCF Rating:Second Camper Name:*Second Camper Gender: Boy Girl Second Camper Birthday (xx/xx/xxxx): Month Day Year Second Camper Grade:USCF Member? Yes No Join Now (White Kings – Top Section must be USCF members) If the child is not a current USCF member and he is enrolled in the Advanced Section, there will be an additional $20 charge to join the US Chess Federation. Players not in the advanced section do not need to join the USCF.USCF ID#:USCF Rating:Third Camper Name:*Third Camper Gender: Boy Girl Third Camper Birthday (xx/xx/xxxx): Month Day Year Third Camper Grade:USCF Member? Yes No Join Now (White Kings – Top Section must be USCF members) If the child is not a current USCF member and he is enrolled in the Advanced Section, there will be an additional $20 charge to join the US Chess Federation. Players not in the advanced section do not need to join the USCF.USCF ID#:USCF Rating:Fourth Camper Name:*Fourth Camper Gender: Boy Girl Fourth Camper Birthday (xx/xx/xxxx): Month Day Year Fourth Camper Grade:USCF Member? Yes No Join Now (White Kings – Top Section must be USCF members) If the child is not a current USCF member and he is enrolled in the Advanced Section, there will be an additional $20 charge to join the US Chess Federation. Players not in the advanced section do not need to join the USCF.USCF ID#:USCF Rating:Fifth Camper Name:*Fifth Camper Gender: Boy Girl Fifth Camper Birthday (xx/xx/xxxx): Month Day Year Fifth Camper Grade:USCF Member? Yes No Join Now (White Kings – Top Section must be USCF members) If the child is not a current USCF member and he is enrolled in the Advanced Section, there will be an additional $20 charge to join the US Chess Federation. Players not in the advanced section do not need to join the USCF.USCF ID#:USCF Rating:Parent Details: Parent's Name:* First Last Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone:*Your Email:* Fee Schedule, Camp Dates & Times: December 23, 24, 26 & 27 9:00 am - 3:00 pm $280.00 per Camper (due with enrollment) Camping Fee of Camper(s): Price: $0.00 Purchase a T-Shirt (T-Shirts will be waiting for you at the camp) T-Shirt Quantity:012345Size of First T-Shirt (additional $18):Youth-SmallMediumLargeAdult-SmallX-LargeXX-LargeSize of Second T-Shirt (additional $18):Youth-SmallMediumLargeAdult-SmallX-LargeXX-LargeSize of Third T-Shirt (additional $18):Youth-SmallMediumLargeAdult-SmallX-LargeXX-LargeSize of Fourth T-Shirt (additional $18):Youth-SmallMediumLargeAdult-SmallX-LargeXX-LargeSize of Fifth T-Shirt (additional $18):Youth-SmallMediumLargeAdult-SmallX-LargeXX-LargeT Shirt PricePayment Details: Total $0.00 Payment Details* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Note:I approve this application and certify the applicant(s) capable of such an experience. I grant permission for the applicant to participate in all camp activities understanding that competent leadership will be provided. In case of accident the camp is authorized to secure emergency medical treatment. The camp is not responsible for lost, stolen or damaged personal articles. I authorize the camp to have and use photographs, slides and video tapes of the person(s) names on this application. Δ
