Pontiac Elementary Registration

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Please complete the following form to register for the after school chess program at Pontiac. Note that for reasons of confidentiality, the school does not provide us with any information about your child or yourself. Therefore, please be sure to include any information that may be relevant whether or not it is on file with the school. The information you submit is entirely confidential and will be used only to administer the after school program at Pontiac.

Child's Name *

Preferred first and last name. Please feel free to also include preferred nicknames such as John "The Obliterator" Smith :)

Grade *

In which grade is your child? Please note that we ask kindergarten and first grade parents to contact us (strategerycg@gmail.com) prior to enrollment to make sure the program is a good fit.

What is your child's chess experience? *

Has your child previously played chess? Has he or she ever participated in a chess program or tournament before?

Mother's Name

Father's Name

Phone Number *

In case of emergency, what is the most reliable phone number by which we might reach you?

E-mail *

What is the most reliable e-mail by which we might reach you?

Additional Notes

Are there any other things we should know about your child? Please especially elaborate on any health or classroom concerns which may be relevant.

E-mail Sign-Up

Parents will receive essential information by email and by text via the Remind app. We also send out optional regular newsletters about community chess events. Would you like to subscribe to our community newsletter?

Yes, please!

No thanks :)

Waiver of Liability *

I/We [as identified in the fields "Mother's Name" and "Father's Name"] specifically release and discharge, in advance, Strategery: Chess and Games, and its directors, employees, instructors, assistants, and volunteers from any and all liability, whether known or unknown. I/We agree to accept responsibility for the risks that may occur through participation in these voluntary chess programs. I/We hereby agree to waive, release and discharge any and all claims for damages, for death, personal injury or property damage which my child may have or which may hereafter accrue as a result of my child’s participation in this program against their person or entity whether such injury or damage was foreseeable. This acknowledgement of and assumption of risk and release shall be binding upon heirs and assigns.

I/We have read and understand the "Waiver of Liability" agreement above and accept the risk and responsibility of participation in this voluntary after-school chess program.

Photo/Video Authorization *

Strategery: Chess and Games takes photos and videos during their programs with the intention of sharing them with parents, with the school, and in promotions of their programs.

I/We [as identified in the fields "Mother's Name" and "Father's Name" and so identified hereafter] hereby authorize release of my child’s name and photograph for distribution regarding Strategery: Chess and Games' programs.

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