Klein Camp Registration | Foundation Chess

2023 Klein Chess Camp Registration Form

Contact and Authorized Pick Up Information

Camper First Name

Primary Email

Address

Camper Last Name

2022-2023 Grade

Home Phone

Camper Date of Birth

School Next Fall

Names of those people who are authorized to pick up your child from camp:

Name #1

Name #2

Relation

Add answer here

Phone

Medical Information - Fill This Section If Needed

Please list any medical conditions or allergies.

Please list any medications that your child is currently taking.

Please list any medications to be administered at camp, dosages, and times to be administered.

Name of Insured

Medical Insurance Company

Type of Policy

Policy Number / Member ID

Group Number

Emergency Treatment Authorization

“In case of an accident or serious illness, I authorize the individuals working with the camp to provide any and all necessary medical treatment for my child, at my expense. I agree to hold the Camp Staff harmless from all liability for any injuries my child may receive while participating in this camp.”

Your Signature

Select a date

Student Behavior Contract

“I will do my best to act respectful and appropriate to: The Camp Staff, Coaches, and other students at all times. I will not roughhouse, tease, or touch any student in a harmful way. I understand that I must notify an adult when I need to leave a classroom area. I know that the classrooms and its equipment are not my own so I must be respectful of all things in it. If I have broken something, the Staff will notify my Parent/Guardian that they will need to replace it. If I am not able to abide by these rules, my Parent/Guardian will be called, and I will be asked not to return to camp. I understand this contract is my responsibility and there will be no behavior issues with me during camp.”

Your Signature

Select a date

Payment Options and How You Heard About Us

Online payment includes fees.

Select Pay by Cash/Check/Zelle/Venmo to avoid online fees.

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Select your method of payment.

Pay by Cash/Check/Zelle/Venmo - Chess Camp Only - $365

Pay by Credit Card/PayPal - Chess Camp Only - $375

Pay by Cash/Check/Zelle/Venmo - Chess Camp with Lunch - $415

Pay by Credit Card/PayPal - Chess Camp with Lunch - $425

Pay by Cash/Check/Zelle/Venmo - Chess Camp with Late Pickup - $427

Pay by Credit Card/PayPal - Chess Camp with Late Pickup - $438

Pay by Cash/Check/Zelle/Venmo - Chess Camp with Lunch and Late Pickup - $475

Pay by Credit Card/PayPal - Chess Camp with Lunch and Late Pickup - $490

How did you hear about us?

I understand that if paying by Cash/Check/Zelle/Venmo I need to select the Manual Payment Option.

I want to subscribe to the newsletter.

Thanks for registering for Summer chess camp!