Zoom 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:

Week One: 4/12 - 4/16
Price: $75.00 per Camper (due with enrollment)

Week Two: 4/19 - 4/23
Price: $75.00 per Camper (due with enrollment)

Week Three: 4/26 - 4/30
Price: $75.00 per Camper (due with enrollment)

Week Four: 5/3 - 5/7
Price: $75.00 per Camper (due with enrollment)

Week Five: 5/10 - 5/14
Price: $75.00 per Camper (due with enrollment)

Week Six: 5/17 - 5/21
Price: $75.00 per Camper (due with enrollment)

Week Seven: 5/24 - 5/28
Price: $75.00 per Camper (due with enrollment)

Week Eight: 5/31 - 6/4
Price: $75.00 per Camper (due with enrollment)

Week Nine: 6/7 - 6/11
Price: $75.00 per Camper (due with enrollment)

Week Ten: 6/14 - 6/18
Price: $75.00 per Camper (due with enrollment)

PLEASE SPECIFY WHICH SESSION YOU ARE SIGNING UP FOR:

Camping Fee of Camper(s):

Price: $0.00

Sessions:

Camping Fee:

Payment Details:

Total

$0.00

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.