Fall Day Camp Enrollment | Mountain Lake Chess Club

Number of Campers:

First Camper Name:*

First Camper Gender:

Boy
Girl

First Camper Birthday (xx/xx/xxxx):

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):

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):

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):

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):

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:

November 25-27, 2019 · 9:00 am - 3:00 pm
Price: $210.00 per Camper (due with enrollment)

Camping Fee of Camper(s):

Price: $210.00

Purchase a T-Shirt

(T-Shirts will be waiting for you at first day of class )

T-Shirt Quantity:

Size of First T-Shirt (additional $18):

Size of Second T-Shirt (additional $18):

Size of Third T-Shirt (additional $18):

Size of Fourth T-Shirt (additional $18):

Size of Fifth T-Shirt (additional $18):

T Shirt Price

Payment Details:

Total

$210.00

Payment Details*

Discover

MasterCard

Visa

Card Number 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.